- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,171.60 / $5,135.00 / $11,627.00
| Facility | | $1,171.60 | $5,135.00 | $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
- $755.37 / $906.44 / $1,121.93
| Facility | | $755.37 | $906.44 | $1,121.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.00 / $902.20 / $21,571.00
| Facility | | $425.00 | $902.20 | $21,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.00 / $600.00 / $1,200.00
| Facility | | $425.00 | $600.00 | $1,200.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $800.00 / $4,072.00 / $6,238.00
| Facility | | $800.00 | $4,072.00 | $6,238.00 |