- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $10,232.93 / $23,988.33
| Facility | | $1,380.38 | $10,232.93 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $758.58 / $8,317.64
| Facility | | $707.95 | $758.58 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,479.11 / $9,549.93
| Facility | | $758.58 | $1,479.11 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,380.38 / $1,479.11
| Facility | | $1,047.13 | $1,380.38 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,000.00 / $2,187.76
| Facility | | $977.24 | $1,000.00 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $20,417.38 / $38,904.51
| Facility | | $13,803.84 | $20,417.38 | $38,904.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $21,379.62 / $41,686.94
| Facility | | $4,265.80 | $21,379.62 | $41,686.94 |