- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,378.46 / $9,062.00 / $18,276.00
| Facility | | $1,378.46 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,136.62 / $8,259.01 / $13,996.40
| Facility | | $3,136.62 | $8,259.01 | $13,996.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $890.00 / $890.00 / $1,355.18
| Facility | | $890.00 | $890.00 | $1,355.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,291.00 / $1,600.59 / $2,678.15
| Facility | | $1,291.00 | $1,600.59 | $2,678.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $16,223.00 / $23,485.00
| Facility | | $2,912.00 | $16,223.00 | $23,485.00 |