- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $3,803.00 / $12,600.00
| Facility | | $1,200.00 | $3,803.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,271.00 / $9,962.39 / $15,740.47
| Facility | | $6,271.00 | $9,962.39 | $15,740.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,937.60 / $1,937.60 / $1,937.60
| Facility | | $1,937.60 | $1,937.60 | $1,937.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,515.00 / $2,420.25 / $5,882.00
| Facility | | $1,515.00 | $2,420.25 | $5,882.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.00 / $2,900.00 / $5,543.93
| Facility | | $884.00 | $2,900.00 | $5,543.93 |