- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,335.45 / $1,669.62 / $8,229.00
| Facility | | $1,335.45 | $1,669.62 | $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
- $1,303.27 / $1,788.81 / $2,063.51
| Facility | | $1,303.27 | $1,788.81 | $2,063.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,577.78 / $1,577.78 / $1,577.78
| Facility | | $1,577.78 | $1,577.78 | $1,577.78 |
- 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 |