- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,993.00 / $5,297.00 / $8,031.00
| Facility | | $2,993.00 | $5,297.00 | $8,031.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,807.00 / $5,786.00 / $10,956.00
| Facility | | $2,807.00 | $5,786.00 | $10,956.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.00 / $3,113.54 / $3,584.65
| Facility | | $1,020.00 | $3,113.54 | $3,584.65 |
- 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
- $911.00 / $5,307.00 / $8,879.00
| Facility | | $911.00 | $5,307.00 | $8,879.00 |