- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,519.82 / $5,866.00 / $16,467.00
| Facility | | $1,519.82 | $5,866.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,808.51 / $8,455.28 / $14,557.93
| Facility | | $3,808.51 | $8,455.28 | $14,557.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $780.00 / $1,459.14 / $6,402.74
| Facility | | $780.00 | $1,459.14 | $6,402.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,421.92 / $1,831.82 / $2,842.88
| Facility | | $1,421.92 | $1,831.82 | $2,842.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $16,223.00 / $23,485.00
| Facility | | $2,912.00 | $16,223.00 | $23,485.00 |