- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,137.66 / $4,610.00 / $7,996.00
| Facility | | $1,137.66 | $4,610.00 | $7,996.00 |
- 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
- $591.00 / $591.00 / $3,311.39
| Facility | | $591.00 | $591.00 | $3,311.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,137.66 / $2,393.57 / $11,258.00
| Facility | | $1,137.66 | $2,393.57 | $11,258.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,842.00 / $4,000.00 / $10,781.00
| Facility | | $1,842.00 | $4,000.00 | $10,781.00 |