- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,213.85 / $4,261.00 / $12,154.00
| Facility | | $1,213.85 | $4,261.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,234.00 / $4,319.00 / $10,043.00
| Facility | | $2,234.00 | $4,319.00 | $10,043.00 |
- 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
- $893.96 / $1,325.77 / $3,044.28
| Facility | | $893.96 | $1,325.77 | $3,044.28 |
- 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 |