- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,307.18 / $4,261.00 / $12,154.00
| Facility | | $1,307.18 | $4,261.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,114.00 / $4,130.00 / $9,364.29
| Facility | | $2,114.00 | $4,130.00 | $9,364.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,530.00 / $2,530.00 / $2,530.00
| Facility | | $2,530.00 | $2,530.00 | $2,530.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,075.69 / $1,565.03 / $3,496.96
| Facility | | $1,075.69 | $1,565.03 | $3,496.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,189.00 / $3,300.00 / $11,186.00
| Facility | | $1,189.00 | $3,300.00 | $11,186.00 |