- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,345.70 / $12,848.42 / $18,545.00
| Facility | | $1,345.70 | $12,848.42 | $18,545.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,357.27 / $11,886.76 / $18,636.72
| Facility | | $6,357.27 | $11,886.76 | $18,636.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $1,340.50 / $6,454.10
| Facility | | $375.00 | $1,340.50 | $6,454.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.83 / $1,546.68 / $2,287.69
| Facility | | $1,148.83 | $1,546.68 | $2,287.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,098.00 / $16,269.00 / $24,457.00
| Facility | | $2,098.00 | $16,269.00 | $24,457.00 |