- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,761.57 / $8,783.00 / $16,639.00
| Facility | | $1,761.57 | $8,783.00 | $16,639.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,142.39 / $10,783.42 / $18,314.23
| Facility | | $5,142.39 | $10,783.42 | $18,314.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $890.00 / $1,748.75
| Facility | | $580.00 | $890.00 | $1,748.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,327.32 / $1,733.88 / $3,424.72
| Facility | | $1,327.32 | $1,733.88 | $3,424.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $16,223.00 / $23,485.00
| Facility | | $2,912.00 | $16,223.00 | $23,485.00 |