- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,207.53 / $9,062.00 / $17,247.00
| Facility | | $2,207.53 | $9,062.00 | $17,247.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,296.60 / $9,261.92 / $16,512.25
| Facility | | $2,296.60 | $9,261.92 | $16,512.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $2,086.03 / $3,845.77
| Facility | | $375.00 | $2,086.03 | $3,845.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,367.00 / $2,113.77 / $3,773.58
| Facility | | $1,367.00 | $2,113.77 | $3,773.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $990.00 / $15,451.00 / $23,485.00
| Facility | | $990.00 | $15,451.00 | $23,485.00 |