- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,491.62 / $8,783.00 / $16,639.00
| Facility | | $1,491.62 | $8,783.00 | $16,639.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,294.50 / $7,206.40 / $12,097.16
| Facility | | $3,294.50 | $7,206.40 | $12,097.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $890.00 / $2,581.96
| Facility | | $580.00 | $890.00 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,170.45 / $1,584.85 / $2,431.89
| Facility | | $1,170.45 | $1,584.85 | $2,431.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $12,456.00 / $19,591.00
| Facility | | $2,155.00 | $12,456.00 | $19,591.00 |