- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,382.97 / $5,866.00 / $16,467.00
| Facility | | $1,382.97 | $5,866.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.44 / $6,277.56 / $10,537.94
| Facility | | $2,951.44 | $6,277.56 | $10,537.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $505.00 / $2,594.85
| Facility | | $505.00 | $505.00 | $2,594.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $1,159.96 / $1,867.01
| Facility | | $860.00 | $1,159.96 | $1,867.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,779.00 / $12,456.00 / $19,591.00
| Facility | | $1,779.00 | $12,456.00 | $19,591.00 |