- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,596.43 / $1,764.62 / $4,846.00
| Facility | | $1,596.43 | $1,764.62 | $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
- $1,470.52 / $1,911.68 / $2,205.78
| Facility | | $1,470.52 | $1,911.68 | $2,205.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $1,903.52
| Facility | | $761.00 | $761.00 | $1,903.52 |
- 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 |