- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,169.59 / $8,960.00 / $16,467.00
| Facility | | $1,169.59 | $8,960.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,792.31 / $9,602.04 / $16,900.34
| Facility | | $3,792.31 | $9,602.04 | $16,900.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $815.00 / $3,711.96 / $4,769.93
| Facility | | $815.00 | $3,711.96 | $4,769.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $994.16 / $1,261.25 / $2,261.03
| Facility | | $994.16 | $1,261.25 | $2,261.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,354.02 / $15,451.00 / $23,485.00
| Facility | | $4,354.02 | $15,451.00 | $23,485.00 |