- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,132.66 / $5,467.00 / $12,237.00
| Facility | | $1,132.66 | $5,467.00 | $12,237.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.00 / $1,094.15 / $2,558.64
| Facility | | $177.00 | $1,094.15 | $2,558.64 |
- 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
- $694.43 / $1,098.58 / $6,239.00
| Facility | | $694.43 | $1,098.58 | $6,239.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,833.00 / $3,946.00 / $6,988.00
| Facility | | $1,833.00 | $3,946.00 | $6,988.00 |