- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,314.23 / $3,377.57 / $17,225.00
| Facility | | $1,314.23 | $3,377.57 | $17,225.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,601.00 / $14,542.00 / $37,919.46
| Facility | | $3,601.00 | $14,542.00 | $37,919.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,270.33 / $1,700.67 / $2,572.44
| Facility | | $1,270.33 | $1,700.67 | $2,572.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $646.00 / $1,065.92 / $14,806.47
| Facility | | $646.00 | $1,065.92 | $14,806.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,554.00 / $12,393.00 / $17,380.00
| Facility | | $3,554.00 | $12,393.00 | $17,380.00 |