- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,069.97 / $1,176.38 / $4,846.00
| Facility | | $1,069.97 | $1,176.38 | $4,846.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,600.00 / $11,226.46 / $15,429.17
| Facility | | $4,600.00 | $11,226.46 | $15,429.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $980.32 / $1,274.42 / $1,470.48
| Facility | | $980.32 | $1,274.42 | $1,470.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $1,267.94
| Facility | | $761.00 | $761.00 | $1,267.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.00 / $5,076.00 / $10,396.00
| Facility | | $612.00 | $5,076.00 | $10,396.00 |