- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,514.16 / $6,754.18 / $9,062.00
| Facility | | $1,514.16 | $6,754.18 | $9,062.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,803.18 / $7,147.82 / $12,212.57
| Facility | | $2,803.18 | $7,147.82 | $12,212.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $625.63 / $7,375.70
| Facility | | $505.00 | $625.63 | $7,375.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $623.27 / $827.23 / $1,215.53
| Facility | | $623.27 | $827.23 | $1,215.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,327.00 / $12,269.00 / $19,591.00
| Facility | | $2,327.00 | $12,269.00 | $19,591.00 |