- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,578.95 / $1,669.25 / $8,229.00
| Facility | | $1,578.95 | $1,669.25 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,049.25 / $9,122.94 / $15,243.15
| Facility | | $5,049.25 | $9,122.94 | $15,243.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,547.86 / $2,124.50 / $2,450.77
| Facility | | $1,547.86 | $2,124.50 | $2,450.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,863.80 / $1,863.80 / $1,863.80
| Facility | | $1,863.80 | $1,863.80 | $1,863.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $405.00 / $2,513.00 / $27,879.00
| Facility | | $405.00 | $2,513.00 | $27,879.00 |