- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,613.35 / $7,218.00 / $11,679.00
| Facility | | $1,613.35 | $7,218.00 | $11,679.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,084.00 / $4,437.00 / $19,117.00
| Facility | | $2,084.00 | $4,437.00 | $19,117.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,142.25 / $1,400.36 / $2,631.55
| Facility | | $1,142.25 | $1,400.36 | $2,631.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,062.67 / $1,938.72 / $21,571.00
| Facility | | $1,062.67 | $1,938.72 | $21,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,938.72 / $2,161.90 / $8,052.64
| Facility | | $1,938.72 | $2,161.90 | $8,052.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,973.63 / $5,605.00 / $9,483.00
| Facility | | $2,973.63 | $5,605.00 | $9,483.00 |