- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.09 / $5,135.00 / $11,627.00
| Facility | | $1,548.09 | $5,135.00 | $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
- $997.34 / $1,196.81 / $1,481.32
| Facility | | $997.34 | $1,196.81 | $1,481.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.00 / $1,192.73 / $21,571.00
| Facility | | $425.00 | $1,192.73 | $21,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.00 / $600.00 / $1,200.00
| Facility | | $425.00 | $600.00 | $1,200.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $925.00 / $5,209.00 / $7,778.00
| Facility | | $925.00 | $5,209.00 | $7,778.00 |