- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,901.03 / $4,392.00 / $10,296.00
| Facility | | $1,901.03 | $4,392.00 | $10,296.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,100.00 / $7,264.00 / $12,697.00
| Facility | | $4,100.00 | $7,264.00 | $12,697.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,316.76 / $3,316.76 / $37,499.62
| Facility | | $3,316.76 | $3,316.76 | $37,499.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,669.26 / $2,669.26 / $7,227.90
| Facility | | $2,669.26 | $2,669.26 | $7,227.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.00 / $3,050.00 / $6,000.53
| Facility | | $319.00 | $3,050.00 | $6,000.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.00 / $2,669.26 / $7,227.90
| Facility | | $555.00 | $2,669.26 | $7,227.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,749.00 / $4,194.00 / $9,300.00
| Facility | | $1,749.00 | $4,194.00 | $9,300.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,022.32 / $3,022.32 / $8,155.26
| Facility | | $3,022.32 | $3,022.32 | $8,155.26 |