- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,187.58 / $4,331.00 / $12,600.00
| Facility | | $1,187.58 | $4,331.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $613.00 / $4,442.97 / $7,045.17
| Facility | | $613.00 | $4,442.97 | $7,045.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $505.00 / $505.00
| Facility | | $505.00 | $505.00 | $505.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $759.23 / $1,187.59 / $11,209.00
| Facility | | $759.23 | $1,187.59 | $11,209.00 |
- 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 |