- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,064.95 / $8,783.00 / $16,639.00
| Facility | | $1,064.95 | $8,783.00 | $16,639.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,860.32 / $10,437.45 / $17,877.47
| Facility | | $4,860.32 | $10,437.45 | $17,877.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $890.00 / $13,819.35
| Facility | | $580.00 | $890.00 | $13,819.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $955.16 / $1,124.72 / $2,039.13
| Facility | | $955.16 | $1,124.72 | $2,039.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $19,526.00 / $24,161.00
| Facility | | $3,028.00 | $19,526.00 | $24,161.00 |