- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,050.00 / $6,560.00 / $12,154.00
| Facility | | $2,050.00 | $6,560.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,831.00 / $6,069.38 / $13,861.24
| Facility | | $2,831.00 | $6,069.38 | $13,861.24 |
- 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
- $1,070.03 / $1,708.25 / $4,960.00
| Facility | | $1,070.03 | $1,708.25 | $4,960.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,967.00 / $4,960.00 / $11,732.00
| Facility | | $1,967.00 | $4,960.00 | $11,732.00 |