- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,130.32 / $8,960.00 / $16,467.00
| Facility | | $1,130.32 | $8,960.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.00 / $4,588.63 / $8,041.18
| Facility | | $2,187.00 | $4,588.63 | $8,041.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $815.00 / $3,208.42 / $4,122.88
| Facility | | $815.00 | $3,208.42 | $4,122.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $905.27 / $1,253.59 / $2,047.51
| Facility | | $905.27 | $1,253.59 | $2,047.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $10,918.00 / $16,901.00
| Facility | | $1,981.00 | $10,918.00 | $16,901.00 |