- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,726.31 / $5,022.93 / $14,023.00
| Facility | | $1,726.31 | $5,022.93 | $14,023.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,905.10 / $4,779.46 / $10,065.60
| Facility | | $2,905.10 | $4,779.46 | $10,065.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,284.00 / $1,284.00 / $1,284.00
| Facility | | $1,284.00 | $1,284.00 | $1,284.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $956.09 / $1,313.08 / $5,851.00
| Facility | | $956.09 | $1,313.08 | $5,851.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,269.00 / $6,170.00 / $12,989.00
| Facility | | $2,269.00 | $6,170.00 | $12,989.00 |