- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,072.72 / $5,467.00 / $12,237.00
| Facility | | $1,072.72 | $5,467.00 | $12,237.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,556.44 / $5,328.84 / $5,975.63
| Facility | | $2,556.44 | $5,328.84 | $5,975.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $624.00 / $14,356.00 / $14,356.00
| Facility | | $624.00 | $14,356.00 | $14,356.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $687.01 / $1,072.72 / $11,209.00
| Facility | | $687.01 | $1,072.72 | $11,209.00 |
- 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 |