- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,386.00 / $2,363.19 / $11,093.00
| Facility | | $1,386.00 | $2,363.19 | $11,093.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,614.00 / $7,572.00 / $18,942.00
| Facility | | $1,614.00 | $7,572.00 | $18,942.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,426.31 / $1,957.68 / $2,936.52
| Facility | | $1,426.31 | $1,957.68 | $2,936.52 |
- 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 |