- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,635.00 / $2,985.23 / $6,681.00
| Facility | | $1,635.00 | $2,985.23 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,112.00 / $2,326.00 / $4,649.00
| Facility | | $1,112.00 | $2,326.00 | $4,649.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $525.00 / $2,277.00
| Facility | | $500.00 | $525.00 | $2,277.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,800.00 / $11,939.83 / $12,240.97
| Facility | | $2,800.00 | $11,939.83 | $12,240.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $2,397.00 / $4,544.00
| Facility | | $875.00 | $2,397.00 | $4,544.00 |