- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,763.84 / $5,939.00 / $12,237.00
| Facility | | $1,763.84 | $5,939.00 | $12,237.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,597.30 / $3,829.41 / $6,069.38
| Facility | | $2,597.30 | $3,829.41 | $6,069.38 |
- 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
- $1,049.91 / $1,649.51 / $11,642.00
| Facility | | $1,049.91 | $1,649.51 | $11,642.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,269.00 / $6,407.00 / $12,989.00
| Facility | | $2,269.00 | $6,407.00 | $12,989.00 |