- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,881.43 / $3,881.43 / $3,881.43
| Facility | | $3,881.43 | $3,881.43 | $3,881.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $743.00 / $1,682.00 / $4,015.00
| Facility | | $743.00 | $1,682.00 | $4,015.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $198.09 / $237.71 / $294.54
| Facility | | $198.09 | $237.71 | $294.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.89 / $2,258.41 / $2,258.41
| Facility | | $257.89 | $2,258.41 | $2,258.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,152.00 / $4,135.00 / $11,284.00
| Facility | | $1,152.00 | $4,135.00 | $11,284.00 |