- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,162.02 / $6,560.00 / $12,154.00
| Facility | | $1,162.02 | $6,560.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,831.00 / $3,829.41 / $6,069.38
| Facility | | $2,831.00 | $3,829.41 | $6,069.38 |
- 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
- $790.58 / $1,292.55 / $6,724.00
| Facility | | $790.58 | $1,292.55 | $6,724.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,269.00 / $6,407.00 / $12,989.00
| Facility | | $2,269.00 | $6,407.00 | $12,989.00 |