- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,387.00 / $4,376.00 / $12,154.00
| Facility | | $1,387.00 | $4,376.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,461.10 / $4,532.06 / $15,970.12
| Facility | | $1,461.10 | $4,532.06 | $15,970.12 |
- 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
- $1,138.32 / $1,797.83 / $11,642.00
| Facility | | $1,138.32 | $1,797.83 | $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 |