- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,014.24 / $8,783.00 / $16,639.00
| Facility | | $1,014.24 | $8,783.00 | $16,639.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,877.26 / $8,455.28 / $14,557.93
| Facility | | $3,877.26 | $8,455.28 | $14,557.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $890.00 / $5,051.60
| Facility | | $580.00 | $890.00 | $5,051.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $902.00 / $1,157.61 / $1,899.56
| Facility | | $902.00 | $1,157.61 | $1,899.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $16,223.00 / $23,485.00
| Facility | | $2,912.00 | $16,223.00 | $23,485.00 |