- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,687.27 / $3,939.75 / $7,403.00
| Facility | | $1,687.27 | $3,939.75 | $7,403.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $945.00 / $2,197.00 / $4,147.00
| Facility | | $945.00 | $2,197.00 | $4,147.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $525.00 / $2,277.00
| Facility | | $500.00 | $525.00 | $2,277.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,413.00 / $11,314.16 / $11,517.68
| Facility | | $5,413.00 | $11,314.16 | $11,517.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,109.00 / $2,473.00 / $4,615.00
| Facility | | $1,109.00 | $2,473.00 | $4,615.00 |