- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,628.49 / $8,960.00 / $16,467.00
| Facility | | $1,628.49 | $8,960.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,792.31 / $9,602.04 / $16,952.09
| Facility | | $3,792.31 | $9,602.04 | $16,952.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $815.00 / $3,711.96 / $4,769.93
| Facility | | $815.00 | $3,711.96 | $4,769.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.02 / $1,636.25 / $3,014.46
| Facility | | $1,275.02 | $1,636.25 | $3,014.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $16,959.00 / $23,485.00
| Facility | | $2,912.00 | $16,959.00 | $23,485.00 |