- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,679.73 / $9,062.00 / $17,247.00
| Facility | | $1,679.73 | $9,062.00 | $17,247.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,399.85 / $9,261.92 / $16,512.25
| Facility | | $2,399.85 | $9,261.92 | $16,512.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $1,584.80 / $3,845.77
| Facility | | $375.00 | $1,584.80 | $3,845.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,151.00 / $1,631.60 / $2,872.25
| Facility | | $1,151.00 | $1,631.60 | $2,872.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $990.00 / $15,451.00 / $23,485.00
| Facility | | $990.00 | $15,451.00 | $23,485.00 |