- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,500.00 / $5,467.00 / $12,237.00
| Facility | | $1,500.00 | $5,467.00 | $12,237.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,339.50 / $2,077.32 / $3,130.84
| Facility | | $1,339.50 | $2,077.32 | $3,130.84 |
- 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
- $398.79 / $624.54 / $4,510.00
| Facility | | $398.79 | $624.54 | $4,510.00 |
- 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 |