- 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
- $1,098.20 / $1,620.02 / $2,568.26
| Facility | | $1,098.20 | $1,620.02 | $2,568.26 |
- 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
- $387.41 / $617.34 / $5,562.00
| Facility | | $387.41 | $617.34 | $5,562.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $871.00 / $2,902.00 / $5,562.00
| Facility | | $871.00 | $2,902.00 | $5,562.00 |