- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,293.77 / $3,489.98 / $16,467.00
| Facility | | $1,293.77 | $3,489.98 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,566.14 / $9,950.93 / $16,952.09
| Facility | | $4,566.14 | $9,950.93 | $16,952.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $890.00 / $4,769.93
| Facility | | $580.00 | $890.00 | $4,769.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,231.25 / $1,616.37 / $2,664.82
| Facility | | $1,231.25 | $1,616.37 | $2,664.82 |
- 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 |