- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.00 / $3,884.21 / $8,240.00
| Facility | | $1,020.00 | $3,884.21 | $8,240.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,150.00 / $7,463.00 / $11,091.00
| Facility | | $4,150.00 | $7,463.00 | $11,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $906.33 / $906.33 / $906.33
| Facility | | $906.33 | $906.33 | $906.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.00 / $4,373.47 / $8,427.00
| Facility | | $1,020.00 | $4,373.47 | $8,427.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $906.33 / $906.33 / $906.33
| Facility | | $906.33 | $906.33 | $906.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $786.81 / $786.81 / $883.10
| Facility | | $786.81 | $786.81 | $883.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $3,475.00 / $6,368.00
| Facility | | $2,155.00 | $3,475.00 | $6,368.00 |