- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $9,120.11 / $16,595.87
| Facility | | $2,089.30 | $9,120.11 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $9,120.11 / $16,218.10
| Facility | | $3,981.07 | $9,120.11 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $2,570.40
| Facility | | $575.44 | $575.44 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,000.00 / $1,659.59
| Facility | | $812.83 | $1,000.00 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $13,182.57 / $23,988.33
| Facility | | $2,137.96 | $13,182.57 | $23,988.33 |