- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $4,677.35 / $14,125.38
| Facility | | $1,288.25 | $4,677.35 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $13,489.63 / $21,877.62
| Facility | | $8,709.64 | $13,489.63 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $891.25
| Facility | | $891.25 | $891.25 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,621.81 / $11,220.18
| Facility | | $1,000.00 | $1,621.81 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $7,762.47 / $14,454.40
| Facility | | $1,949.84 | $7,762.47 | $14,454.40 |