- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,628.64 / $5,431.14 / $11,627.00
| Facility | | $1,628.64 | $5,431.14 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,785.00 / $8,239.18 / $15,310.83
| Facility | | $2,785.00 | $8,239.18 | $15,310.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,560.16 / $1,872.19 / $2,317.23
| Facility | | $1,560.16 | $1,872.19 | $2,317.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.00 / $1,200.00 / $21,571.00
| Facility | | $425.00 | $1,200.00 | $21,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.00 / $600.00 / $1,863.80
| Facility | | $425.00 | $600.00 | $1,863.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $650.00 / $2,883.00 / $6,111.00
| Facility | | $650.00 | $2,883.00 | $6,111.00 |