- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,416.80 / $5,866.00 / $16,467.00
| Facility | | $1,416.80 | $5,866.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,063.02 / $2,405.69 / $3,831.65
| Facility | | $1,063.02 | $2,405.69 | $3,831.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $890.00 / $890.00 / $1,405.09
| Facility | | $890.00 | $890.00 | $1,405.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,304.06 / $1,622.38 / $2,733.06
| Facility | | $1,304.06 | $1,622.38 | $2,733.06 |
- 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 |