- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,771.64 / $2,287.92 / $8,229.00
| Facility | | $1,771.64 | $2,287.92 | $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
- $2,121.53 / $2,911.90 / $3,359.09
| Facility | | $2,121.53 | $2,911.90 | $3,359.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,563.40 / $2,563.40 / $2,563.40
| Facility | | $2,563.40 | $2,563.40 | $2,563.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $405.00 / $2,780.92 / $27,879.00
| Facility | | $405.00 | $2,780.92 | $27,879.00 |