- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,216.85 / $2,318.00 / $11,093.00
| Facility | | $1,216.85 | $2,318.00 | $11,093.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,515.81 / $7,572.00 / $18,942.00
| Facility | | $1,515.81 | $7,572.00 | $18,942.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.66 / $1,658.47 / $2,487.71
| Facility | | $1,258.66 | $1,658.47 | $2,487.71 |
- 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 |