- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,548.48 / $6,560.00 / $13,151.00
| Facility | | $2,548.48 | $6,560.00 | $13,151.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,209.00 / $2,986.15 / $5,952.49
| Facility | | $2,209.00 | $2,986.15 | $5,952.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $624.00 / $624.00 / $624.00
| Facility | | $624.00 | $624.00 | $624.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,581.73 / $2,685.75 / $5,463.06
| Facility | | $1,581.73 | $2,685.75 | $5,463.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,433.30 / $4,960.00 / $11,618.00
| Facility | | $1,433.30 | $4,960.00 | $11,618.00 |