- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,930.00 / $7,016.00 / $13,523.00
| Facility | | $1,930.00 | $7,016.00 | $13,523.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $827.00 / $9,112.87 / $9,592.51
| Facility | | $827.00 | $9,112.87 | $9,592.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $710.00 / $710.00 / $710.00
| Facility | | $710.00 | $710.00 | $710.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.77 / $1,081.25 / $15,898.00
| Facility | | $691.77 | $1,081.25 | $15,898.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,729.00 / $8,000.00 / $17,483.00
| Facility | | $2,729.00 | $8,000.00 | $17,483.00 |