- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,707.83 / $8,408.18 / $23,194.00
| Facility | | $1,707.83 | $8,408.18 | $23,194.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.00 / $5,869.13 / $9,721.67
| Facility | | $2,187.00 | $5,869.13 | $9,721.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,486.00 / $2,486.00 / $3,194.56
| Facility | | $2,486.00 | $2,486.00 | $3,194.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $639.58 / $956.51 / $1,495.07
| Facility | | $639.58 | $956.51 | $1,495.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $12,798.00 / $19,665.00
| Facility | | $2,155.00 | $12,798.00 | $19,665.00 |