- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,311.98 / $8,960.00 / $16,467.00
| Facility | | $1,311.98 | $8,960.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,792.31 / $9,602.04 / $16,952.09
| Facility | | $3,792.31 | $9,602.04 | $16,952.09 |
- 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
- $1,124.51 / $1,496.00 / $2,604.96
| Facility | | $1,124.51 | $1,496.00 | $2,604.96 |
- 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 |