- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,757.00 / $6,071.00 / $13,151.00
| Facility | | $2,757.00 | $6,071.00 | $13,151.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $613.00 / $4,029.09 / $4,241.14
| Facility | | $613.00 | $4,029.09 | $4,241.14 |
- 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
- $840.25 / $1,310.48 / $11,209.00
| Facility | | $840.25 | $1,310.48 | $11,209.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,967.00 / $4,960.00 / $11,702.05
| Facility | | $1,967.00 | $4,960.00 | $11,702.05 |