- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,091.54 / $5,866.00 / $16,467.00
| Facility | | $1,091.54 | $5,866.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,237.07 / $4,803.12 / $8,557.95
| Facility | | $2,237.07 | $4,803.12 | $8,557.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $890.00 / $1,088.75 / $1,965.14
| Facility | | $890.00 | $1,088.75 | $1,965.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $805.83 / $1,091.54 / $2,095.54
| Facility | | $805.83 | $1,091.54 | $2,095.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $729.00 / $6,607.00 / $8,667.00
| Facility | | $729.00 | $6,607.00 | $8,667.00 |