- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,207.98 / $2,318.00 / $7,212.00
| Facility | | $1,207.98 | $2,318.00 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,310.00 / $6,340.00 / $15,727.00
| Facility | | $2,310.00 | $6,340.00 | $15,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,163.80 / $1,512.94 / $1,745.70
| Facility | | $1,163.80 | $1,512.94 | $1,745.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.09 / $5,248.09 / $6,221.10
| Facility | | $5,248.09 | $5,248.09 | $6,221.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,472.00 / $10,113.00 / $15,750.00
| Facility | | $4,472.00 | $10,113.00 | $15,750.00 |