- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,482.78 / $4,261.00 / $12,154.00
| Facility | | $1,482.78 | $4,261.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,114.00 / $4,050.00 / $9,663.00
| Facility | | $2,114.00 | $4,050.00 | $9,663.00 |
- 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
- $1,228.14 / $1,832.99 / $4,180.99
| Facility | | $1,228.14 | $1,832.99 | $4,180.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,285.00 / $4,000.00 / $9,817.00
| Facility | | $2,285.00 | $4,000.00 | $9,817.00 |