- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,193.18 / $9,062.00 / $18,276.00
| Facility | | $1,193.18 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,339.30 / $9,031.54 / $15,441.07
| Facility | | $4,339.30 | $9,031.54 | $15,441.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.00 / $715.00 / $2,594.85
| Facility | | $715.00 | $715.00 | $2,594.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $747.00 / $1,020.96 / $1,610.79
| Facility | | $747.00 | $1,020.96 | $1,610.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,779.00 / $12,456.00 / $19,591.00
| Facility | | $1,779.00 | $12,456.00 | $19,591.00 |