- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,300.00 / $5,511.00 / $16,900.00
| Facility | | $1,300.00 | $5,511.00 | $16,900.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,227.34 / $8,304.37 / $13,120.82
| Facility | | $5,227.34 | $8,304.37 | $13,120.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,545.78 / $2,545.78 / $2,545.78
| Facility | | $2,545.78 | $2,545.78 | $2,545.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.82 / $715.08 / $5,170.00
| Facility | | $524.82 | $715.08 | $5,170.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.00 / $1,990.00 / $4,012.00
| Facility | | $575.00 | $1,990.00 | $4,012.00 |