- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,317.08 / $2,318.00 / $11,093.00
| Facility | | $1,317.08 | $2,318.00 | $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
- $1,367.13 / $1,801.39 / $2,702.09
| Facility | | $1,367.13 | $1,801.39 | $2,702.09 |
- 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 |