- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,245.00 / $4,308.02 / $12,600.00
| Facility | | $1,245.00 | $4,308.02 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,597.30 / $4,754.28 / $6,069.38
| Facility | | $2,597.30 | $4,754.28 | $6,069.38 |
- 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
- $775.87 / $1,215.56 / $11,642.00
| Facility | | $775.87 | $1,215.56 | $11,642.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,269.00 / $6,407.00 / $12,989.00
| Facility | | $2,269.00 | $6,407.00 | $12,989.00 |