- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,742.00 / $18,600.00
| Facility | | $1,000.00 | $3,742.00 | $18,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.79 / $1,783.71 / $2,818.24
| Facility | | $1,122.79 | $1,783.71 | $2,818.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $980.74 / $980.74 / $980.74
| Facility | | $980.74 | $980.74 | $980.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.83 / $118.14 / $2,637.00
| Facility | | $55.83 | $118.14 | $2,637.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $1,327.00 / $2,637.00
| Facility | | $375.00 | $1,327.00 | $2,637.00 |