- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,152.33 / $5,866.00 / $16,467.00
| Facility | | $1,152.33 | $5,866.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,783.09 / $10,824.58 / $17,240.66
| Facility | | $4,783.09 | $10,824.58 | $17,240.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $890.00 / $1,141.83
| Facility | | $505.00 | $890.00 | $1,141.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.75 / $1,334.81 / $2,127.58
| Facility | | $988.75 | $1,334.81 | $2,127.58 |
- 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 |