- 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
- $1,461.10 / $2,151.96 / $4,532.06
| Facility | | $1,461.10 | $2,151.96 | $4,532.06 |
- 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
- $909.95 / $1,431.16 / $11,642.00
| Facility | | $909.95 | $1,431.16 | $11,642.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,269.00 / $6,407.00 / $12,989.00
| Facility | | $2,269.00 | $6,407.00 | $12,989.00 |