- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,771.96 / $3,019.07 / $12,154.00
| Facility | | $1,771.96 | $3,019.07 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,234.00 / $4,319.00 / $10,043.00
| Facility | | $2,234.00 | $4,319.00 | $10,043.00 |
- 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
- $1,567.13 / $2,480.10 / $5,197.43
| Facility | | $1,567.13 | $2,480.10 | $5,197.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,189.00 / $3,300.00 / $11,186.00
| Facility | | $1,189.00 | $3,300.00 | $11,186.00 |