- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,153.22 / $9,062.00 / $20,498.00
| Facility | | $1,153.22 | $9,062.00 | $20,498.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,474.08 / $11,301.77 / $19,407.11
| Facility | | $4,474.08 | $11,301.77 | $19,407.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $890.00 / $1,141.83 / $7,275.65
| Facility | | $890.00 | $1,141.83 | $7,275.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,126.11 / $1,376.78 / $2,272.48
| Facility | | $1,126.11 | $1,376.78 | $2,272.48 |
- 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 |