- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,216.00 / $3,066.00 / $7,799.00
| Facility | | $1,216.00 | $3,066.00 | $7,799.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,639.91 / $11,851.00 / $26,582.19
| Facility | | $8,639.91 | $11,851.00 | $26,582.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,748.75 / $1,748.75 / $1,748.75
| Facility | | $1,748.75 | $1,748.75 | $1,748.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,013.00 / $3,839.00 / $8,017.00
| Facility | | $1,013.00 | $3,839.00 | $8,017.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,748.75 / $1,748.75 / $1,748.75
| Facility | | $1,748.75 | $1,748.75 | $1,748.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,507.12 / $1,507.12 / $1,615.46
| Facility | | $1,507.12 | $1,507.12 | $1,615.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,332.00 / $3,879.00 / $7,508.00
| Facility | | $2,332.00 | $3,879.00 | $7,508.00 |