- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,032.63 / $2,653.86 / $14,063.00
| Facility | | $1,032.63 | $2,653.86 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,807.00 / $6,653.00 / $11,752.00
| Facility | | $2,807.00 | $6,653.00 | $11,752.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $993.19 / $1,329.63 / $2,011.22
| Facility | | $993.19 | $1,329.63 | $2,011.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $560.00 / $798.00 / $1,627.38
| Facility | | $560.00 | $798.00 | $1,627.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,340.85 / $5,995.00 / $10,413.00
| Facility | | $1,340.85 | $5,995.00 | $10,413.00 |