- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $4,470.00 / $12,154.00
| Facility | | $1,200.00 | $4,470.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,419.30 / $2,150.96 / $3,392.25
| Facility | | $1,419.30 | $2,150.96 | $3,392.25 |
- 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
- $680.18 / $1,063.24 / $5,565.00
| Facility | | $680.18 | $1,063.24 | $5,565.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,436.00 / $3,096.00 / $5,562.00
| Facility | | $1,436.00 | $3,096.00 | $5,562.00 |