- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,538.00 / $5,297.00 / $8,031.00
| Facility | | $2,538.00 | $5,297.00 | $8,031.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,613.00 / $4,400.00 / $9,920.00
| Facility | | $2,613.00 | $4,400.00 | $9,920.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $998.00 / $6,305.06 / $10,309.14
| Facility | | $998.00 | $6,305.06 | $10,309.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,277.04 / $2,468.46 / $2,597.87
| Facility | | $1,277.04 | $2,468.46 | $2,597.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,048.00 / $7,771.00 / $11,371.00
| Facility | | $1,048.00 | $7,771.00 | $11,371.00 |