- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,547.00 / $4,908.00 / $12,154.00
| Facility | | $1,547.00 | $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 / $1,135.71
| Facility | | $730.00 | $730.00 | $1,135.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $760.75 / $2,237.00 / $26,542.00
| Facility | | $760.75 | $2,237.00 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,644.00 / $2,874.00 / $5,813.00
| Facility | | $1,644.00 | $2,874.00 | $5,813.00 |