- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,132.24 / $5,866.00 / $16,467.00
| Facility | | $1,132.24 | $5,866.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $848.67 / $1,831.01 / $3,078.72
| Facility | | $848.67 | $1,831.01 | $3,078.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $1,115.11 / $6,094.29
| Facility | | $580.00 | $1,115.11 | $6,094.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,102.46 / $1,351.00 / $2,151.96
| Facility | | $1,102.46 | $1,351.00 | $2,151.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,550.00 / $10,257.00 / $16,249.00
| Facility | | $1,550.00 | $10,257.00 | $16,249.00 |