- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,690.54 / $4,747.00 / $10,439.00
| Facility | | $1,690.54 | $4,747.00 | $10,439.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,988.70 / $3,241.55 / $3,681.95
| Facility | | $2,988.70 | $3,241.55 | $3,681.95 |
- 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
- $601.32 / $1,224.41 / $2,872.00
| Facility | | $601.32 | $1,224.41 | $2,872.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,900.00 / $2,843.00 / $6,239.00
| Facility | | $1,900.00 | $2,843.00 | $6,239.00 |