- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,550.10 / $10,868.00 / $34,363.19
| Facility | | $1,550.10 | $10,868.00 | $34,363.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,740.35 / $9,602.04 / $16,900.34
| Facility | | $3,740.35 | $9,602.04 | $16,900.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,130.00 / $3,711.96 / $4,769.93
| Facility | | $1,130.00 | $3,711.96 | $4,769.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,320.96 / $1,677.89 / $2,999.97
| Facility | | $1,320.96 | $1,677.89 | $2,999.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $16,959.00 / $23,485.00
| Facility | | $2,912.00 | $16,959.00 | $23,485.00 |