- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $4,376.00 / $12,600.00
| Facility | | $1,200.00 | $4,376.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $246.72 / $651.39 / $1,642.26
| Facility | | $246.72 | $651.39 | $1,642.26 |
- 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
- $380.87 / $611.51 / $3,016.29
| Facility | | $380.87 | $611.51 | $3,016.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,521.00 / $3,016.29 / $5,562.00
| Facility | | $1,521.00 | $3,016.29 | $5,562.00 |