- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,881.55 / $7,655.00 / $13,151.00
| Facility | | $1,881.55 | $7,655.00 | $13,151.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,668.58 / $4,223.82 / $6,272.22
| Facility | | $3,668.58 | $4,223.82 | $6,272.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $914.00 / $914.00 / $914.00
| Facility | | $914.00 | $914.00 | $914.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,012.48 / $1,599.32 / $3,133.00
| Facility | | $1,012.48 | $1,599.32 | $3,133.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $787.00 / $1,826.55 / $5,562.00
| Facility | | $787.00 | $1,826.55 | $5,562.00 |