- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,201.52 / $2,541.73 / $14,644.00
| Facility | | $1,201.52 | $2,541.73 | $14,644.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,717.57 / $9,602.04 / $16,952.09
| Facility | | $4,717.57 | $9,602.04 | $16,952.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.00 / $1,100.00 / $6,325.99
| Facility | | $715.00 | $1,100.00 | $6,325.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $992.67 / $1,855.35 / $3,320.67
| Facility | | $992.67 | $1,855.35 | $3,320.67 |
- 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 |