- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,750.92 / $5,144.00 / $9,823.00
| Facility | | $1,750.92 | $5,144.00 | $9,823.00 |
- 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 / $1,756.75
| Facility | | $591.00 | $591.00 | $1,756.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,379.71 / $7,826.76
| Facility | | $55.00 | $2,379.71 | $7,826.76 |
- 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 |