- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,374.73 / $11,018.00 / $16,467.00
| Facility | | $1,374.73 | $11,018.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,328.47 / $9,252.14 / $15,602.02
| Facility | | $4,328.47 | $9,252.14 | $15,602.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.00 / $715.00 / $4,297.39
| Facility | | $715.00 | $715.00 | $4,297.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $952.00 / $1,308.36 / $1,937.12
| Facility | | $952.00 | $1,308.36 | $1,937.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.00 / $10,257.00 / $16,249.00
| Facility | | $1,258.00 | $10,257.00 | $16,249.00 |