- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,415.48 / $2,678.00 / $6,681.00
| Facility | | $1,415.48 | $2,678.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,678.00 / $3,611.00 / $5,774.00
| Facility | | $1,678.00 | $3,611.00 | $5,774.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $514.00 / $605.00 / $2,277.00
| Facility | | $514.00 | $605.00 | $2,277.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $9,511.60 / $9,727.12
| Facility | | $2,000.00 | $9,511.60 | $9,727.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,236.00 / $4,027.00 / $7,669.00
| Facility | | $1,236.00 | $4,027.00 | $7,669.00 |