- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,284.10 / $5,930.50 / $9,047.15
| Facility | | $1,284.10 | $5,930.50 | $9,047.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,786.46 / $6,391.81 / $11,947.84
| Facility | | $2,786.46 | $6,391.81 | $11,947.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $554.63 / $7,646.60
| Facility | | $505.00 | $554.63 | $7,646.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $536.45 / $701.19 / $1,040.14
| Facility | | $536.45 | $701.19 | $1,040.14 |
- 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 |