- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,076.04 / $9,062.00 / $18,276.00
| Facility | | $1,076.04 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,160.92 / $4,890.35 / $7,789.04
| Facility | | $2,160.92 | $4,890.35 | $7,789.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $890.00 / $890.00 / $1,065.64
| Facility | | $890.00 | $890.00 | $1,065.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,044.97 / $1,307.41 / $2,072.67
| Facility | | $1,044.97 | $1,307.41 | $2,072.67 |
- 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 |