- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,039.10 / $3,888.00 / $9,062.00
| Facility | | $1,039.10 | $3,888.00 | $9,062.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $850.00 / $2,414.91 / $7,305.43
| Facility | | $850.00 | $2,414.91 | $7,305.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $621.05 / $2,221.46
| Facility | | $375.00 | $621.05 | $2,221.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $410.44 / $1,498.49 / $2,478.62
| Facility | | $410.44 | $1,498.49 | $2,478.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,224.00 / $12,456.00 / $19,665.00
| Facility | | $1,224.00 | $12,456.00 | $19,665.00 |