- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,000.00 / $6,560.00 / $13,151.00
| Facility | | $3,000.00 | $6,560.00 | $13,151.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,597.30 / $3,829.41 / $6,069.38
| Facility | | $2,597.30 | $3,829.41 | $6,069.38 |
- 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
- $1,248.45 / $1,942.31 / $4,960.00
| Facility | | $1,248.45 | $1,942.31 | $4,960.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,967.00 / $4,960.00 / $11,732.00
| Facility | | $1,967.00 | $4,960.00 | $11,732.00 |