- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,052.63 / $9,062.00 / $18,276.00
| Facility | | $1,052.63 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,909.58 / $9,336.14 / $15,602.02
| Facility | | $4,909.58 | $9,336.14 | $15,602.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,077.12 / $3,077.12 / $3,077.12
| Facility | | $3,077.12 | $3,077.12 | $3,077.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $813.01 / $1,052.63 / $1,526.71
| Facility | | $813.01 | $1,052.63 | $1,526.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,666.00 / $16,223.00 / $23,485.00
| Facility | | $2,666.00 | $16,223.00 | $23,485.00 |