- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,052.14 / $5,866.00 / $16,467.00
| Facility | | $1,052.14 | $5,866.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,511.30 / $11,396.22 / $19,507.71
| Facility | | $5,511.30 | $11,396.22 | $19,507.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $1,043.05 / $2,345.00
| Facility | | $505.00 | $1,043.05 | $2,345.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $863.66 / $1,052.14 / $1,898.04
| Facility | | $863.66 | $1,052.14 | $1,898.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $19,526.00 / $24,161.00
| Facility | | $3,028.00 | $19,526.00 | $24,161.00 |