- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,216.83 / $2,318.00 / $11,093.00
| Facility | | $1,216.83 | $2,318.00 | $11,093.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,614.00 / $9,200.00 / $18,942.00
| Facility | | $1,614.00 | $9,200.00 | $18,942.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,210.25 / $1,542.48 / $1,779.78
| Facility | | $1,210.25 | $1,542.48 | $1,779.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,610.75 / $1,610.75 / $1,610.75
| Facility | | $1,610.75 | $1,610.75 | $1,610.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,364.00 / $6,094.00 / $10,413.00
| Facility | | $3,364.00 | $6,094.00 | $10,413.00 |