- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,687.52 / $5,458.00 / $12,237.00
| Facility | | $1,687.52 | $5,458.00 | $12,237.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,722.70 / $4,011.76 / $6,358.63
| Facility | | $2,722.70 | $4,011.76 | $6,358.63 |
- 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
- $1,137.89 / $1,816.16 / $4,197.89
| Facility | | $1,137.89 | $1,816.16 | $4,197.89 |
- 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 |