- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $896.00 / $2,133.00 / $6,681.00
| Facility | | $896.00 | $2,133.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,370.00 / $3,457.00 / $5,774.00
| Facility | | $1,370.00 | $3,457.00 | $5,774.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $373.00 / $1,487.00 / $2,596.44
| Facility | | $373.00 | $1,487.00 | $2,596.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,293.28 / $10,639.60 / $12,000.00
| Facility | | $5,293.28 | $10,639.60 | $12,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,351.00 / $6,285.00
| Facility | | $1,000.00 | $3,351.00 | $6,285.00 |