- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.58 / $9,062.00 / $18,276.00
| Facility | | $1,047.58 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,608.58 / $9,413.49 / $16,081.56
| Facility | | $3,608.58 | $9,413.49 | $16,081.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,021.41 / $2,021.41 / $2,597.55
| Facility | | $2,021.41 | $2,021.41 | $2,597.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $798.86 / $1,104.00 / $1,756.63
| Facility | | $798.86 | $1,104.00 | $1,756.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,186.00 / $12,456.00 / $22,523.00
| Facility | | $5,186.00 | $12,456.00 | $22,523.00 |