- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,766.18 / $4,995.14 / $9,898.39
| Facility | | $1,766.18 | $4,995.14 | $9,898.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,077.74 / $8,075.94 / $13,928.18
| Facility | | $3,077.74 | $8,075.94 | $13,928.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $2,106.17 / $2,706.47
| Facility | | $580.00 | $2,106.17 | $2,706.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $654.30 / $872.42 / $1,422.20
| Facility | | $654.30 | $872.42 | $1,422.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $16,959.00 / $23,485.00
| Facility | | $2,912.00 | $16,959.00 | $23,485.00 |