- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,255.06 / $8,783.00 / $19,696.93
| Facility | | $2,255.06 | $8,783.00 | $19,696.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,313.90 / $7,093.82 / $11,780.16
| Facility | | $3,313.90 | $7,093.82 | $11,780.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $890.00 / $2,581.96
| Facility | | $580.00 | $890.00 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $926.12 / $1,154.97 / $1,967.32
| Facility | | $926.12 | $1,154.97 | $1,967.32 |
- 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 |