- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $4,897.79 / $16,218.10
| Facility | | $1,000.00 | $4,897.79 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $18,620.87 / $26,302.68
| Facility | | $9,549.93 | $18,620.87 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $891.25 / $1,023.29
| Facility | | $870.96 | $891.25 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,258.93 / $1,778.28
| Facility | | $891.25 | $1,258.93 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $6,025.60 / $10,715.19
| Facility | | $1,288.25 | $6,025.60 | $10,715.19 |