- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,053.56 / $1,176.95 / $4,846.00
| Facility | | $1,053.56 | $1,176.95 | $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
- $980.79 / $1,275.03 / $1,471.19
| Facility | | $980.79 | $1,275.03 | $1,471.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $1,246.46
| Facility | | $761.00 | $761.00 | $1,246.46 |
- 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 |