- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,459.77 / $4,261.00 / $12,154.00
| Facility | | $1,459.77 | $4,261.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,234.00 / $4,358.00 / $12,405.97
| Facility | | $2,234.00 | $4,358.00 | $12,405.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,530.00 / $2,530.00 / $2,530.00
| Facility | | $2,530.00 | $2,530.00 | $2,530.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,247.32 / $1,886.82 / $3,500.00
| Facility | | $1,247.32 | $1,886.82 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,438.00 / $2,874.00 / $5,813.00
| Facility | | $1,438.00 | $2,874.00 | $5,813.00 |