- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,162.22 / $7,799.00 / $16,467.00
| Facility | | $1,162.22 | $7,799.00 | $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
- $890.00 / $890.00 / $1,144.79
| Facility | | $890.00 | $890.00 | $1,144.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,127.53 / $1,418.44 / $2,234.35
| Facility | | $1,127.53 | $1,418.44 | $2,234.35 |
- 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 |