- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,230.23 / $9,243.32 / $13,453.86
| Facility | | $2,230.23 | $9,243.32 | $13,453.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,491.37 / $6,273.95 / $10,769.22
| Facility | | $2,491.37 | $6,273.95 | $10,769.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.00 / $960.09 / $2,581.96
| Facility | | $715.00 | $960.09 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $889.89 / $1,068.82 / $1,830.18
| Facility | | $889.89 | $1,068.82 | $1,830.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $12,456.00 / $19,591.00
| Facility | | $2,155.00 | $12,456.00 | $19,591.00 |