- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,765.79 / $5,721.10 / $9,863.00
| Facility | | $1,765.79 | $5,721.10 | $9,863.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,639.35 / $6,136.22 / $10,500.74
| Facility | | $2,639.35 | $6,136.22 | $10,500.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $769.64 / $890.00 / $2,581.96
| Facility | | $769.64 | $890.00 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.10 / $921.58 / $1,454.24
| Facility | | $688.10 | $921.58 | $1,454.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,550.00 / $10,257.00 / $16,249.00
| Facility | | $1,550.00 | $10,257.00 | $16,249.00 |