- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,611.62 / $8,783.00 / $16,639.00
| Facility | | $1,611.62 | $8,783.00 | $16,639.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,634.92 / $5,364.75 / $9,222.64
| Facility | | $2,634.92 | $5,364.75 | $9,222.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,608.72 / $1,965.14 / $2,345.00
| Facility | | $1,608.72 | $1,965.14 | $2,345.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,448.99 / $1,785.57 / $3,123.50
| Facility | | $1,448.99 | $1,785.57 | $3,123.50 |
- 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 |