- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,059.65 / $7,655.00 / $13,151.00
| Facility | | $2,059.65 | $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
- $1,031.00 / $1,750.70 / $3,133.00
| Facility | | $1,031.00 | $1,750.70 | $3,133.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $783.00 / $1,743.00 / $5,562.00
| Facility | | $783.00 | $1,743.00 | $5,562.00 |