- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,402.02 / $9,062.00 / $18,276.00
| Facility | | $1,402.02 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,813.91 / $11,405.05 / $20,815.55
| Facility | | $4,813.91 | $11,405.05 | $20,815.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.00 / $1,100.00 / $23,044.63
| Facility | | $715.00 | $1,100.00 | $23,044.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,378.65 / $1,682.42 / $2,710.19
| Facility | | $1,378.65 | $1,682.42 | $2,710.19 |
- 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 |