- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,131.00 / $7,655.00 / $14,450.00
| Facility | | $3,131.00 | $7,655.00 | $14,450.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,481.00 / $3,471.76 / $5,505.21
| Facility | | $2,481.00 | $3,471.76 | $5,505.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,782.00 / $3,365.00 / $3,365.00
| Facility | | $1,782.00 | $3,365.00 | $3,365.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $868.70 / $1,247.07 / $8,280.00
| Facility | | $868.70 | $1,247.07 | $8,280.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,967.00 / $4,960.00 / $11,732.00
| Facility | | $1,967.00 | $4,960.00 | $11,732.00 |