- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,517.51 / $5,355.00 / $10,817.74
| Facility | | $1,517.51 | $5,355.00 | $10,817.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,084.00 / $4,426.00 / $19,117.00
| Facility | | $2,084.00 | $4,426.00 | $19,117.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,223.08 / $1,499.45 / $3,758.86
| Facility | | $1,223.08 | $1,499.45 | $3,758.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,141.57 / $2,769.23 / $21,571.00
| Facility | | $1,141.57 | $2,769.23 | $21,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,769.23 / $2,769.23 / $3,088.02
| Facility | | $2,769.23 | $2,769.23 | $3,088.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $6,231.00 / $10,075.00
| Facility | | $2,912.00 | $6,231.00 | $10,075.00 |