- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,447.62 / $8,783.00 / $16,639.00
| Facility | | $1,447.62 | $8,783.00 | $16,639.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,634.92 / $5,364.75 / $9,222.64
| Facility | | $2,634.92 | $5,364.75 | $9,222.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,429.96 / $1,965.14 / $2,345.00
| Facility | | $1,429.96 | $1,965.14 | $2,345.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,394.38 / $1,628.34 / $2,797.87
| Facility | | $1,394.38 | $1,628.34 | $2,797.87 |
- 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 |