- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,930.00 / $4,919.00 / $12,600.00
| Facility | | $1,930.00 | $4,919.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,597.30 / $3,829.41 / $6,069.38
| Facility | | $2,597.30 | $3,829.41 | $6,069.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $505.00 / $505.00
| Facility | | $505.00 | $505.00 | $505.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $815.81 / $1,281.80 / $11,209.00
| Facility | | $815.81 | $1,281.80 | $11,209.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,257.00 / $5,376.20 / $9,008.00
| Facility | | $2,257.00 | $5,376.20 | $9,008.00 |