- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,725.37 / $6,560.00 / $13,151.00
| Facility | | $1,725.37 | $6,560.00 | $13,151.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $681.00 / $4,237.55 / $5,166.16
| Facility | | $681.00 | $4,237.55 | $5,166.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $624.00 / $624.00 / $624.00
| Facility | | $624.00 | $624.00 | $624.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,094.86 / $1,725.37 / $5,323.00
| Facility | | $1,094.86 | $1,725.37 | $5,323.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,967.00 / $4,960.00 / $11,732.00
| Facility | | $1,967.00 | $4,960.00 | $11,732.00 |