- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,700.00 / $4,613.35 / $12,154.00
| Facility | | $1,700.00 | $4,613.35 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,015.30 / $4,231.39 / $7,045.17
| Facility | | $3,015.30 | $4,231.39 | $7,045.17 |
- 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
- $361.42 / $607.16 / $3,125.00
| Facility | | $361.42 | $607.16 | $3,125.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,521.00 / $2,566.00 / $5,562.00
| Facility | | $1,521.00 | $2,566.00 | $5,562.00 |