- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,198.57 / $4,874.00 / $12,237.00
| Facility | | $1,198.57 | $4,874.00 | $12,237.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,356.94 / $3,306.44 / $5,505.21
| Facility | | $2,356.94 | $3,306.44 | $5,505.21 |
- 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
- $713.44 / $1,090.32 / $3,810.00
| Facility | | $713.44 | $1,090.32 | $3,810.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $825.00 / $2,081.00 / $3,918.00
| Facility | | $825.00 | $2,081.00 | $3,918.00 |