- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,274.00 / $3,701.00 / $10,439.00
| Facility | | $1,274.00 | $3,701.00 | $10,439.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,039.77 / $1,039.77 / $1,039.77
| Facility | | $1,039.77 | $1,039.77 | $1,039.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $596.00 / $993.00 / $1,098.00
| Facility | | $596.00 | $993.00 | $1,098.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $247.28 / $986.94 / $2,018.23
| Facility | | $247.28 | $986.94 | $2,018.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $816.00 / $2,127.41 / $3,918.00
| Facility | | $816.00 | $2,127.41 | $3,918.00 |