- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,581.28 / $9,062.00 / $18,276.00
| Facility | | $1,581.28 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,511.46 / $11,396.22 / $19,507.71
| Facility | | $4,511.46 | $11,396.22 | $19,507.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $890.00 / $890.00 / $1,543.14
| Facility | | $890.00 | $890.00 | $1,543.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,488.00 / $1,901.00 / $3,000.00
| Facility | | $1,488.00 | $1,901.00 | $3,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $19,526.00 / $24,161.00
| Facility | | $3,028.00 | $19,526.00 | $24,161.00 |