- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $2,344.23 / $4,897.79
| Facility | | $1,148.15 | $2,344.23 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $17,378.01 / $25,703.96
| Facility | | $8,317.64 | $17,378.01 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,122.02 / $1,174.90
| Facility | | $1,000.00 | $1,122.02 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,778.28 / $2,630.27
| Facility | | $1,122.02 | $1,778.28 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $5,754.40 / $12,022.64
| Facility | | $1,412.54 | $5,754.40 | $12,022.64 |