- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,131.00 / $7,365.00 / $13,151.00
| Facility | | $3,131.00 | $7,365.00 | $13,151.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,594.00 / $6,854.81 / $9,893.29
| Facility | | $3,594.00 | $6,854.81 | $9,893.29 |
- 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
- $1,157.07 / $1,559.66 / $4,552.00
| Facility | | $1,157.07 | $1,559.66 | $4,552.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $787.00 / $1,934.00 / $5,562.00
| Facility | | $787.00 | $1,934.00 | $5,562.00 |