- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,185.40 / $7,799.00 / $16,467.00
| Facility | | $1,185.40 | $7,799.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,689.05 / $6,085.57 / $9,692.69
| Facility | | $2,689.05 | $6,085.57 | $9,692.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $560.00 / $615.00
| Facility | | $100.00 | $560.00 | $615.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,001.65 / $1,202.00 / $2,019.45
| Facility | | $1,001.65 | $1,202.00 | $2,019.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,224.00 / $12,269.00 / $19,665.00
| Facility | | $1,224.00 | $12,269.00 | $19,665.00 |