- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,094.57 / $5,866.00 / $16,467.00
| Facility | | $1,094.57 | $5,866.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,709.21 / $5,405.49 / $8,981.33
| Facility | | $2,709.21 | $5,405.49 | $8,981.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $505.00 / $3,200.28
| Facility | | $505.00 | $505.00 | $3,200.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $823.00 / $1,085.83 / $1,440.23
| Facility | | $823.00 | $1,085.83 | $1,440.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $12,798.00 / $19,665.00
| Facility | | $2,155.00 | $12,798.00 | $19,665.00 |