- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,254.00 / $6,956.00 / $13,151.00
| Facility | | $1,254.00 | $6,956.00 | $13,151.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,597.30 / $3,647.06 / $6,069.38
| Facility | | $2,597.30 | $3,647.06 | $6,069.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $985.00 / $985.00 / $985.00
| Facility | | $985.00 | $985.00 | $985.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $485.05 / $760.32 / $5,562.00
| Facility | | $485.05 | $760.32 | $5,562.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,436.00 / $3,096.00 / $5,565.00
| Facility | | $1,436.00 | $3,096.00 | $5,565.00 |