- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,243.00 / $1,831.33 / $13,304.00
| Facility | | $1,243.00 | $1,831.33 | $13,304.00 |
- 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
- $1,412.12 / $1,938.22 / $2,235.86
| Facility | | $1,412.12 | $1,938.22 | $2,235.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,696.76 / $1,696.76 / $1,696.76
| Facility | | $1,696.76 | $1,696.76 | $1,696.76 |
- 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 |