- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,033.23 / $7,799.00 / $16,467.00
| Facility | | $1,033.23 | $7,799.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,634.28 / $10,818.29 / $19,712.46
| Facility | | $4,634.28 | $10,818.29 | $19,712.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.00 / $1,030.51 / $5,740.31
| Facility | | $715.00 | $1,030.51 | $5,740.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $873.31 / $1,177.18 / $1,949.14
| Facility | | $873.31 | $1,177.18 | $1,949.14 |
- 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 |