- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.92 / $5,467.00 / $13,151.00
| Facility | | $1,122.92 | $5,467.00 | $13,151.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,152.04 / $4,788.88 / $7,981.47
| Facility | | $1,152.04 | $4,788.88 | $7,981.47 |
- 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
- $668.41 / $1,045.40 / $11,642.00
| Facility | | $668.41 | $1,045.40 | $11,642.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,269.00 / $6,407.00 / $12,224.00
| Facility | | $2,269.00 | $6,407.00 | $12,224.00 |