- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,704.65 / $5,939.00 / $13,151.00
| Facility | | $1,704.65 | $5,939.00 | $13,151.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,597.30 / $3,829.41 / $8,064.81
| Facility | | $2,597.30 | $3,829.41 | $8,064.81 |
- 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
- $1,092.36 / $1,704.65 / $12,989.00
| Facility | | $1,092.36 | $1,704.65 | $12,989.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,820.00 / $9,507.00 / $11,245.29
| Facility | | $2,820.00 | $9,507.00 | $11,245.29 |