- 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
- $2,556.44 / $3,588.53 / $5,975.63
| Facility | | $2,556.44 | $3,588.53 | $5,975.63 |
- 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
- $822.40 / $1,283.48 / $6,239.00
| Facility | | $822.40 | $1,283.48 | $6,239.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,779.00 / $3,946.00 / $6,307.00
| Facility | | $1,779.00 | $3,946.00 | $6,307.00 |