- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,862.09 / $3,715.35
| Facility | | $1,122.02 | $1,862.09 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,230.27 / $1,737.80
| Facility | | $588.84 | $1,230.27 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,318.26 / $1,905.46
| Facility | | $302.00 | $1,318.26 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $77.62 / $162.18
| Facility | | $54.95 | $77.62 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $1,000.00 / $1,288.25
| Facility | | $151.36 | $1,000.00 | $1,288.25 |