- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,553.00 / $6,071.00 / $13,151.00
| Facility | | $2,553.00 | $6,071.00 | $13,151.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $737.00 / $4,016.65 / $4,228.05
| Facility | | $737.00 | $4,016.65 | $4,228.05 |
- 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
- $744.67 / $1,164.50 / $11,642.00
| Facility | | $744.67 | $1,164.50 | $11,642.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,250.00 / $6,145.00 / $13,573.09
| Facility | | $1,250.00 | $6,145.00 | $13,573.09 |