- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,097.79 / $4,723.00 / $11,627.00
| Facility | | $1,097.79 | $4,723.00 | $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
- $1,050.09 / $1,260.11 / $1,559.67
| Facility | | $1,050.09 | $1,260.11 | $1,559.67 |
- 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 / $1,261.02
| Facility | | $425.00 | $600.00 | $1,261.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.00 / $7,705.00 / $12,871.00
| Facility | | $1,275.00 | $7,705.00 | $12,871.00 |