- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,635.20 / $8,783.00 / $16,639.00
| Facility | | $1,635.20 | $8,783.00 | $16,639.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,143.48 / $5,363.06 / $9,222.64
| Facility | | $2,143.48 | $5,363.06 | $9,222.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,629.96 / $1,965.14 / $2,345.00
| Facility | | $1,629.96 | $1,965.14 | $2,345.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,565.51 / $1,776.66 / $3,163.15
| Facility | | $1,565.51 | $1,776.66 | $3,163.15 |
- 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 |