- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,930.00 / $5,650.84 / $12,237.00
| Facility | | $1,930.00 | $5,650.84 | $12,237.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,991.00 / $2,779.67 / $4,627.91
| Facility | | $1,991.00 | $2,779.67 | $4,627.91 |
- 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
- $492.50 / $771.34 / $5,562.00
| Facility | | $492.50 | $771.34 | $5,562.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $871.00 / $2,902.00 / $5,565.00
| Facility | | $871.00 | $2,902.00 | $5,565.00 |