- 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
- $361.00 / $2,936.42 / $3,090.97
| Facility | | $361.00 | $2,936.42 | $3,090.97 |
- 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
- $786.50 / $1,222.25 / $6,988.00
| Facility | | $786.50 | $1,222.25 | $6,988.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,779.00 / $3,946.00 / $6,988.00
| Facility | | $1,779.00 | $3,946.00 | $6,988.00 |