- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,209.63 / $9,062.00 / $18,276.00
| Facility | | $1,209.63 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,717.57 / $9,950.93 / $16,952.09
| Facility | | $4,717.57 | $9,950.93 | $16,952.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.00 / $1,100.00 / $4,769.93
| Facility | | $715.00 | $1,100.00 | $4,769.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,209.18 / $1,469.05 / $2,451.67
| Facility | | $1,209.18 | $1,469.05 | $2,451.67 |
- 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 |