- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,783.11 / $5,560.00 / $13,618.00
| Facility | | $1,783.11 | $5,560.00 | $13,618.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,340.00 / $10,500.00 / $32,783.00
| Facility | | $2,340.00 | $10,500.00 | $32,783.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,530.00 / $24,415.00 / $29,229.00
| Facility | | $2,530.00 | $24,415.00 | $29,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,706.13 / $2,545.78 / $7,500.00
| Facility | | $1,706.13 | $2,545.78 | $7,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,189.00 / $8,198.00 / $12,661.00
| Facility | | $1,189.00 | $8,198.00 | $12,661.00 |