- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,294.58 / $4,846.00 / $11,093.00
| Facility | | $1,294.58 | $4,846.00 | $11,093.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,614.00 / $7,572.00 / $18,942.00
| Facility | | $1,614.00 | $7,572.00 | $18,942.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,253.70 / $1,629.81 / $1,880.55
| Facility | | $1,253.70 | $1,629.81 | $1,880.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,610.75 / $1,610.75 / $1,909.39
| Facility | | $1,610.75 | $1,610.75 | $1,909.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,364.00 / $6,032.00 / $10,413.00
| Facility | | $3,364.00 | $6,032.00 | $10,413.00 |