- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,207.41 / $9,062.00 / $18,276.00
| Facility | | $1,207.41 | $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 / $1,200.02
| Facility | | $890.00 | $890.00 | $1,200.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,153.77 / $1,368.00 / $2,323.56
| Facility | | $1,153.77 | $1,368.00 | $2,323.56 |
- 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 |