- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,186.30 / $9,062.00 / $16,467.00
| Facility | | $1,186.30 | $9,062.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,447.53 / $9,261.92 / $16,512.25
| Facility | | $1,447.53 | $9,261.92 | $16,512.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $1,121.54 / $3,845.77
| Facility | | $375.00 | $1,121.54 | $3,845.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.00 / $1,186.30 / $1,992.89
| Facility | | $616.00 | $1,186.30 | $1,992.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $710.00 / $10,069.00 / $16,249.00
| Facility | | $710.00 | $10,069.00 | $16,249.00 |