- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,066.23 / $4,908.00 / $12,154.00
| Facility | | $1,066.23 | $4,908.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,247.00 / $9,663.00
| Facility | | $2,088.00 | $4,247.00 | $9,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $730.00 / $730.00 / $1,756.75
| Facility | | $730.00 | $730.00 | $1,756.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $984.69 / $2,652.29 / $26,542.00
| Facility | | $984.69 | $2,652.29 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,748.00 / $3,502.00 / $6,854.00
| Facility | | $1,748.00 | $3,502.00 | $6,854.00 |