- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,228.17 / $3,589.00 / $10,923.00
| Facility | | $1,228.17 | $3,589.00 | $10,923.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,294.00 / $5,965.00 / $16,201.00
| Facility | | $2,294.00 | $5,965.00 | $16,201.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,813.00 / $9,841.00 / $14,444.00
| Facility | | $5,813.00 | $9,841.00 | $14,444.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $963.04 / $1,608.34 / $19,067.25
| Facility | | $963.04 | $1,608.34 | $19,067.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,209.00 / $4,963.00 / $12,486.00
| Facility | | $2,209.00 | $4,963.00 | $12,486.00 |