- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,014.84 / $4,376.00 / $12,154.00
| Facility | | $1,014.84 | $4,376.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,461.10 / $2,151.96 / $4,532.06
| Facility | | $1,461.10 | $2,151.96 | $4,532.06 |
- 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
- $642.59 / $1,014.84 / $11,642.00
| Facility | | $642.59 | $1,014.84 | $11,642.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,798.00 / $6,724.00 / $12,989.00
| Facility | | $2,798.00 | $6,724.00 | $12,989.00 |