- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,289.18 / $3,948.03 / $16,467.00
| Facility | | $1,289.18 | $3,948.03 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,031.66 / $5,044.83 / $8,588.78
| Facility | | $2,031.66 | $5,044.83 | $8,588.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.00 / $1,100.00 / $7,275.65
| Facility | | $715.00 | $1,100.00 | $7,275.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,289.18 / $1,656.45 / $2,702.56
| Facility | | $1,289.18 | $1,656.45 | $2,702.56 |
- 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 |