- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,401.42 / $1,538.92 / $8,229.00
| Facility | | $1,401.42 | $1,538.92 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,923.72 / $7,537.12 / $11,845.28
| Facility | | $3,923.72 | $7,537.12 | $11,845.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,365.92 / $1,874.80 / $2,162.71
| Facility | | $1,365.92 | $1,874.80 | $2,162.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,644.26 / $1,644.26 / $1,644.26
| Facility | | $1,644.26 | $1,644.26 | $1,644.26 |
- 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 |