- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,517.00 / $2,678.00 / $6,681.00
| Facility | | $1,517.00 | $2,678.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,201.00 / $5,060.00 / $9,272.00
| Facility | | $2,201.00 | $5,060.00 | $9,272.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.00 / $2,813.00 / $4,038.10
| Facility | | $625.00 | $2,813.00 | $4,038.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,532.24 / $16,547.20 / $26,542.00
| Facility | | $5,532.24 | $16,547.20 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,001.00 / $3,160.00 / $6,285.00
| Facility | | $1,001.00 | $3,160.00 | $6,285.00 |