- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,535.00 / $5,458.00 / $12,237.00
| Facility | | $1,535.00 | $5,458.00 | $12,237.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,339.50 / $2,794.08 / $3,168.77
| Facility | | $1,339.50 | $2,794.08 | $3,168.77 |
- 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
- $635.20 / $951.06 / $3,331.00
| Facility | | $635.20 | $951.06 | $3,331.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $825.00 / $2,081.00 / $3,918.00
| Facility | | $825.00 | $2,081.00 | $3,918.00 |