- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,632.01 / $5,194.00 / $8,031.00
| Facility | | $1,632.01 | $5,194.00 | $8,031.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,807.00 / $4,945.58 / $12,591.48
| Facility | | $2,807.00 | $4,945.58 | $12,591.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $998.00 / $998.00 / $998.00
| Facility | | $998.00 | $998.00 | $998.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $626.58 / $886.65 / $1,945.41
| Facility | | $626.58 | $886.65 | $1,945.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $762.00 / $4,738.00 / $16,193.00
| Facility | | $762.00 | $4,738.00 | $16,193.00 |