- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,438.53 / $6,603.19 / $13,151.00
| Facility | | $2,438.53 | $6,603.19 | $13,151.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,166.00 / $4,280.76 / $6,787.73
| Facility | | $3,166.00 | $4,280.76 | $6,787.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $914.00 / $914.00 / $914.00
| Facility | | $914.00 | $914.00 | $914.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,417.84 / $1,941.49 / $8,280.00
| Facility | | $1,417.84 | $1,941.49 | $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 |