- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $5,623.41 / $10,471.29
| Facility | | $1,862.09 | $5,623.41 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $15,135.61 / $16,218.10
| Facility | | $2,754.23 | $15,135.61 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $630.96 / $630.96
| Facility | | $630.96 | $630.96 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,621.81 / $14,454.40
| Facility | | $1,000.00 | $1,621.81 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $6,918.31 / $12,302.69
| Facility | | $2,818.38 | $6,918.31 | $12,302.69 |