- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $4,376.00 / $12,154.00
| Facility | | $1,200.00 | $4,376.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $763.71 / $2,431.19 / $3,069.39
| Facility | | $763.71 | $2,431.19 | $3,069.39 |
- 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
- $624.98 / $1,016.91 / $3,125.00
| Facility | | $624.98 | $1,016.91 | $3,125.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,436.00 / $3,096.00 / $5,565.00
| Facility | | $1,436.00 | $3,096.00 | $5,565.00 |