- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,722.05 / $5,464.00 / $12,237.00
| Facility | | $1,722.05 | $5,464.00 | $12,237.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,597.30 / $3,829.41 / $8,064.81
| Facility | | $2,597.30 | $3,829.41 | $8,064.81 |
- 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
- $1,343.81 / $2,098.06 / $12,989.00
| Facility | | $1,343.81 | $2,098.06 | $12,989.00 |
- 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 |