- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,136.67 / $7,157.73 / $11,627.00
| Facility | | $2,136.67 | $7,157.73 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,802.00 / $13,811.09 / $24,478.90
| Facility | | $2,802.00 | $13,811.09 | $24,478.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,033.30 / $2,439.96 / $3,019.98
| Facility | | $2,033.30 | $2,439.96 | $3,019.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.00 / $1,200.00 / $21,571.00
| Facility | | $425.00 | $1,200.00 | $21,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.00 / $600.00 / $2,450.09
| Facility | | $425.00 | $600.00 | $2,450.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $650.00 / $2,883.00 / $6,111.00
| Facility | | $650.00 | $2,883.00 | $6,111.00 |