- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,211.51 / $5,922.00 / $12,075.00
| Facility | | $2,211.51 | $5,922.00 | $12,075.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,574.00 / $7,631.00 / $14,193.00
| Facility | | $4,574.00 | $7,631.00 | $14,193.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,571.75 / $2,571.75 / $37,499.62
| Facility | | $2,571.75 | $2,571.75 | $37,499.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,080.21 / $2,080.21 / $7,227.90
| Facility | | $2,080.21 | $2,080.21 | $7,227.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.00 / $2,385.00 / $4,756.82
| Facility | | $319.00 | $2,385.00 | $4,756.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.00 / $2,080.21 / $7,227.90
| Facility | | $555.00 | $2,080.21 | $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
- $2,083.76 / $2,083.76 / $5,833.58
| Facility | | $2,083.76 | $2,083.76 | $5,833.58 |