- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,971.92 / $2,578.29 / $3,614.91
| Facility | | $1,971.92 | $2,578.29 | $3,614.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,161.00 / $2,750.71 / $5,986.99
| Facility | | $2,161.00 | $2,750.71 | $5,986.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $492.16 / $492.16 / $2,398.14
| Facility | | $492.16 | $492.16 | $2,398.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,172.00 / $4,086.00 / $7,778.00
| Facility | | $1,172.00 | $4,086.00 | $7,778.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $20,038.96 / $24,071.36
| Facility | | $55.00 | $20,038.96 | $24,071.36 |