- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,745.85 / $9,062.00 / $18,276.00
| Facility | | $1,745.85 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,783.09 / $10,824.58 / $17,240.66
| Facility | | $4,783.09 | $10,824.58 | $17,240.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $890.00 / $890.00 / $1,728.24
| Facility | | $890.00 | $890.00 | $1,728.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.97 / $2,132.44 / $3,205.17
| Facility | | $1,621.97 | $2,132.44 | $3,205.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $19,526.00 / $24,161.00
| Facility | | $3,028.00 | $19,526.00 | $24,161.00 |