- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,627.80 / $7,609.00 / $14,644.00
| Facility | | $2,627.80 | $7,609.00 | $14,644.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,781.87 / $6,725.88 / $12,569.54
| Facility | | $2,781.87 | $6,725.88 | $12,569.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.00 / $2,144.17 / $2,755.30
| Facility | | $715.00 | $2,144.17 | $2,755.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $447.27 / $626.77 / $1,045.92
| Facility | | $447.27 | $626.77 | $1,045.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $12,798.00 / $19,665.00
| Facility | | $2,155.00 | $12,798.00 | $19,665.00 |