- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,797.00 / $5,467.00 / $12,237.00
| Facility | | $1,797.00 | $5,467.00 | $12,237.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $613.00 / $4,265.14 / $9,973.87
| Facility | | $613.00 | $4,265.14 | $9,973.87 |
- 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
- $1,063.47 / $2,190.00 / $6,427.00
| Facility | | $1,063.47 | $2,190.00 | $6,427.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,967.00 / $4,960.00 / $11,732.00
| Facility | | $1,967.00 | $4,960.00 | $11,732.00 |