- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,804.08 / $6,411.83 / $16,467.00
| Facility | | $2,804.08 | $6,411.83 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,831.01 / $1,831.01 / $1,831.01
| Facility | | $1,831.01 | $1,831.01 | $1,831.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $560.00 / $615.00
| Facility | | $100.00 | $560.00 | $615.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,973.45 / $2,713.17 / $4,779.10
| Facility | | $1,973.45 | $2,713.17 | $4,779.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $454.00 / $6,074.00 / $8,818.00
| Facility | | $454.00 | $6,074.00 | $8,818.00 |