- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,300.00 / $5,405.00 / $16,900.00
| Facility | | $1,300.00 | $5,405.00 | $16,900.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.20 / $674.17 / $912.98
| Facility | | $606.20 | $674.17 | $912.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,070.25 / $1,070.25 / $1,070.25
| Facility | | $1,070.25 | $1,070.25 | $1,070.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.78 / $942.00 / $5,962.62
| Facility | | $625.78 | $942.00 | $5,962.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.00 / $2,875.93 / $5,543.93
| Facility | | $884.00 | $2,875.93 | $5,543.93 |