- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,041.75 / $9,072.48 / $16,467.00
| Facility | | $1,041.75 | $9,072.48 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,529.70 / $7,290.55 / $12,354.53
| Facility | | $3,529.70 | $7,290.55 | $12,354.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.00 / $715.00 / $3,424.28
| Facility | | $715.00 | $715.00 | $3,424.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.00 / $1,001.70 / $1,512.93
| Facility | | $688.00 | $1,001.70 | $1,512.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,666.00 / $16,223.00 / $23,485.00
| Facility | | $2,666.00 | $16,223.00 | $23,485.00 |