- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,788.86 / $6,088.00 / $11,627.00
| Facility | | $1,788.86 | $6,088.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,644.00 / $6,446.55 / $12,695.35
| Facility | | $2,644.00 | $6,446.55 | $12,695.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,706.68 / $2,048.02 / $2,534.86
| Facility | | $1,706.68 | $2,048.02 | $2,534.86 |
- 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 / $2,053.92
| Facility | | $425.00 | $600.00 | $2,053.92 |
- 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 |