- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,700.00 / $5,467.00 / $12,237.00
| Facility | | $1,700.00 | $5,467.00 | $12,237.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $984.20 / $1,381.68 / $2,299.67
| Facility | | $984.20 | $1,381.68 | $2,299.67 |
- 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
- $769.11 / $1,203.75 / $4,510.00
| Facility | | $769.11 | $1,203.75 | $4,510.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,436.00 / $3,096.00 / $5,565.00
| Facility | | $1,436.00 | $3,096.00 | $5,565.00 |