- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,930.00 / $4,376.00 / $12,154.00
| Facility | | $1,930.00 | $4,376.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,594.10 / $2,251.80 / $3,726.84
| Facility | | $1,594.10 | $2,251.80 | $3,726.84 |
- 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
- $1,342.00 / $2,298.51 / $4,423.00
| Facility | | $1,342.00 | $2,298.51 | $4,423.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,436.00 / $3,096.00 / $5,562.00
| Facility | | $1,436.00 | $3,096.00 | $5,562.00 |