- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,988.63 / $6,752.95 / $11,627.00
| Facility | | $1,988.63 | $6,752.95 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,501.00 / $13,621.30 / $25,522.00
| Facility | | $3,501.00 | $13,621.30 | $25,522.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,906.45 / $2,287.73 / $2,831.57
| Facility | | $1,906.45 | $2,287.73 | $2,831.57 |
- 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 / $2,284.78
| Facility | | $425.00 | $600.00 | $2,284.78 |
- 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 |