- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,463.50 / $8,236.79 / $11,627.00
| Facility | | $2,463.50 | $8,236.79 | $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
- $2,352.76 / $2,823.31 / $3,494.46
| Facility | | $2,352.76 | $2,823.31 | $3,494.46 |
- 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 / $2,818.19
| Facility | | $425.00 | $600.00 | $2,818.19 |
- 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 |