- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,397.32 / $5,260.80 / $12,237.00
| Facility | | $1,397.32 | $5,260.80 | $12,237.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,041.23 / $9,457.77 / $15,762.94
| Facility | | $3,041.23 | $9,457.77 | $15,762.94 |
- 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
- $895.55 / $1,397.32 / $12,989.00
| Facility | | $895.55 | $1,397.32 | $12,989.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,798.00 / $6,724.00 / $13,689.00
| Facility | | $2,798.00 | $6,724.00 | $13,689.00 |