- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,722.55 / $5,700.00 / $12,075.00
| Facility | | $1,722.55 | $5,700.00 | $12,075.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,100.00 / $7,264.00 / $12,274.00
| Facility | | $4,100.00 | $7,264.00 | $12,274.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,049.31 / $3,478.50 / $13,477.50
| Facility | | $2,049.31 | $3,478.50 | $13,477.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,573.68 / $1,573.68 / $10,297.11
| Facility | | $1,573.68 | $1,573.68 | $10,297.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $332.00 / $2,116.00 / $3,642.05
| Facility | | $332.00 | $2,116.00 | $3,642.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.00 / $1,573.68 / $10,297.11
| Facility | | $555.00 | $1,573.68 | $10,297.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,337.00 / $6,450.00 / $12,742.00
| Facility | | $2,337.00 | $6,450.00 | $12,742.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,492.84 / $1,492.84 / $4,534.16
| Facility | | $1,492.84 | $1,492.84 | $4,534.16 |