- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,245.00 / $3,885.00 / $10,468.34
| Facility | | $1,245.00 | $3,885.00 | $10,468.34 |
- 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
- $786.46 / $1,228.30 / $11,209.00
| Facility | | $786.46 | $1,228.30 | $11,209.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.00 / $4,916.00 / $11,769.00
| Facility | | $1,202.00 | $4,916.00 | $11,769.00 |