- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,538.00 / $5,244.00 / $8,031.00
| Facility | | $2,538.00 | $5,244.00 | $8,031.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,807.00 / $4,945.58 / $11,936.00
| Facility | | $2,807.00 | $4,945.58 | $11,936.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.00 / $4,240.96 / $6,934.21
| Facility | | $1,020.00 | $4,240.96 | $6,934.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $735.56 / $1,023.56 / $2,255.33
| Facility | | $735.56 | $1,023.56 | $2,255.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $833.00 / $6,442.00 / $9,973.00
| Facility | | $833.00 | $6,442.00 | $9,973.00 |