- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,511.15 / $8,783.00 / $16,639.00
| Facility | | $1,511.15 | $8,783.00 | $16,639.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,143.48 / $5,363.06 / $9,195.94
| Facility | | $2,143.48 | $5,363.06 | $9,195.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,505.40 / $1,965.14 / $2,345.00
| Facility | | $1,505.40 | $1,965.14 | $2,345.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,463.66 / $1,638.14 / $2,916.09
| Facility | | $1,463.66 | $1,638.14 | $2,916.09 |
- 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 |