- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,818.84 / $9,062.00 / $18,276.00
| Facility | | $1,818.84 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,574.76 / $9,263.14 / $15,459.94
| Facility | | $4,574.76 | $9,263.14 | $15,459.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,594.85 / $2,594.85 / $2,594.85
| Facility | | $2,594.85 | $2,594.85 | $2,594.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $940.00 / $1,535.28 / $2,455.42
| Facility | | $940.00 | $1,535.28 | $2,455.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,779.00 / $12,456.00 / $19,591.00
| Facility | | $1,779.00 | $12,456.00 | $19,591.00 |