- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,400.00 / $4,790.80 / $12,154.00
| Facility | | $2,400.00 | $4,790.80 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,135.00 / $1,534.38 / $2,429.98
| Facility | | $1,135.00 | $1,534.38 | $2,429.98 |
- 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
- $1,485.00 / $2,625.78 / $4,893.87
| Facility | | $1,485.00 | $2,625.78 | $4,893.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,436.00 / $3,096.00 / $5,565.00
| Facility | | $1,436.00 | $3,096.00 | $5,565.00 |