- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,097.02 / $7,655.00 / $14,450.00
| Facility | | $2,097.02 | $7,655.00 | $14,450.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,140.66 / $2,455.46 / $2,518.42
| Facility | | $2,140.66 | $2,455.46 | $2,518.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,782.00 / $3,365.00 / $3,365.00
| Facility | | $1,782.00 | $3,365.00 | $3,365.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,224.19 / $1,780.42 / $8,280.00
| Facility | | $1,224.19 | $1,780.42 | $8,280.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,967.00 / $4,960.00 / $11,732.00
| Facility | | $1,967.00 | $4,960.00 | $11,732.00 |