- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,322.00 / $5,812.26 / $10,808.00
| Facility | | $1,322.00 | $5,812.26 | $10,808.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,022.94 / $3,306.44 / $5,505.21
| Facility | | $3,022.94 | $3,306.44 | $5,505.21 |
- 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
- $844.96 / $1,322.00 / $8,419.00
| Facility | | $844.96 | $1,322.00 | $8,419.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,967.00 / $4,960.00 / $11,732.00
| Facility | | $1,967.00 | $4,960.00 | $11,732.00 |