- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,018.67 / $9,062.00 / $18,276.00
| Facility | | $1,018.67 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,109.54 / $10,783.42 / $18,360.62
| Facility | | $5,109.54 | $10,783.42 | $18,360.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,016.63 / $1,255.00 / $7,560.42
| Facility | | $1,016.63 | $1,255.00 | $7,560.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $1,201.84 / $1,952.95
| Facility | | $953.00 | $1,201.84 | $1,952.95 |
- 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 |