- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $4,470.00 / $12,600.00
| Facility | | $1,200.00 | $4,470.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,339.50 / $1,975.66 / $3,130.84
| Facility | | $1,339.50 | $1,975.66 | $3,130.84 |
- 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
- $695.15 / $1,087.33 / $3,810.00
| Facility | | $695.15 | $1,087.33 | $3,810.00 |
- 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 |