- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,000.00 / $7,016.00 / $13,151.00
| Facility | | $3,000.00 | $7,016.00 | $13,151.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,451.02 / $3,451.02 / $3,451.02
| Facility | | $3,451.02 | $3,451.02 | $3,451.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $914.00 / $3,365.00 / $3,365.00
| Facility | | $914.00 | $3,365.00 | $3,365.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.52 / $1,082.78 / $4,650.00
| Facility | | $758.52 | $1,082.78 | $4,650.00 |
- 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 |