- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,215.96 / $2,747.00 / $8,229.00
| Facility | | $2,215.96 | $2,747.00 | $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
- $2,665.38 / $3,658.37 / $4,220.18
| Facility | | $2,665.38 | $3,658.37 | $4,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,204.37 / $3,204.37 / $3,204.37
| Facility | | $3,204.37 | $3,204.37 | $3,204.37 |
- 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 |