- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,822.00 / $4,470.00 / $10,439.00
| Facility | | $1,822.00 | $4,470.00 | $10,439.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,339.50 / $1,881.58 / $3,130.84
| Facility | | $1,339.50 | $1,881.58 | $3,130.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $442.00 / $442.00 / $442.00
| Facility | | $442.00 | $442.00 | $442.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $517.84 / $811.60 / $3,331.00
| Facility | | $517.84 | $811.60 | $3,331.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $825.00 / $2,081.00 / $3,918.00
| Facility | | $825.00 | $2,081.00 | $3,918.00 |