- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,190.81 / $9,062.00 / $18,276.00
| Facility | | $1,190.81 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,041.58 / $6,454.34 / $11,190.33
| Facility | | $3,041.58 | $6,454.34 | $11,190.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,100.00 / $1,180.30 / $5,740.31
| Facility | | $1,100.00 | $1,180.30 | $5,740.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,040.00 / $1,309.89 / $2,145.12
| Facility | | $1,040.00 | $1,309.89 | $2,145.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $12,456.00 / $19,591.00
| Facility | | $2,155.00 | $12,456.00 | $19,591.00 |