- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,717.26 / $2,108.50 / $2,719.55
| Facility | | $1,717.26 | $2,108.50 | $2,719.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,830.00 / $8,584.00 / $11,253.00
| Facility | | $5,830.00 | $8,584.00 | $11,253.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,472.32 / $3,461.25 / $4,079.33
| Facility | | $2,472.32 | $3,461.25 | $4,079.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,845.75 / $3,063.18 / $3,063.18
| Facility | | $1,845.75 | $3,063.18 | $3,063.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $599.00 / $4,298.00 / $30,001.00
| Facility | | $599.00 | $4,298.00 | $30,001.00 |