- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,873.62 / $7,655.00 / $13,151.00
| Facility | | $1,873.62 | $7,655.00 | $13,151.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,824.00 / $5,170.37 / $8,195.79
| Facility | | $3,824.00 | $5,170.37 | $8,195.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $914.00 / $914.00 / $914.00
| Facility | | $914.00 | $914.00 | $914.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.91 / $1,358.60 / $2,214.36
| Facility | | $891.91 | $1,358.60 | $2,214.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $783.00 / $1,743.00 / $5,562.00
| Facility | | $783.00 | $1,743.00 | $5,562.00 |