- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,302.02 / $4,376.00 / $12,600.00
| Facility | | $1,302.02 | $4,376.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $613.00 / $3,866.53 / $4,070.03
| Facility | | $613.00 | $3,866.53 | $4,070.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $505.00 / $505.00
| Facility | | $505.00 | $505.00 | $505.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $833.43 / $1,302.02 / $6,988.00
| Facility | | $833.43 | $1,302.02 | $6,988.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,195.00 / $3,647.00 / $8,348.00
| Facility | | $1,195.00 | $3,647.00 | $8,348.00 |