- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,131.00 / $7,655.00 / $13,151.00
| Facility | | $3,131.00 | $7,655.00 | $13,151.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,328.00 / $1,799.82 / $3,312.14
| Facility | | $1,328.00 | $1,799.82 | $3,312.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $914.00 / $914.00 / $914.00
| Facility | | $914.00 | $914.00 | $914.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,087.00 / $2,734.10 / $4,275.54
| Facility | | $1,087.00 | $2,734.10 | $4,275.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $783.00 / $1,743.00 / $5,562.00
| Facility | | $783.00 | $1,743.00 | $5,562.00 |