- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,155.00 / $2,036.00 / $15,104.00
| Facility | | $1,155.00 | $2,036.00 | $15,104.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.61 / $4,073.61 / $4,073.61
| Facility | | $4,073.61 | $4,073.61 | $4,073.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,343.00 / $3,607.00 / $4,765.00
| Facility | | $2,343.00 | $3,607.00 | $4,765.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,374.00 / $1,500.00 / $5,091.00
| Facility | | $1,374.00 | $1,500.00 | $5,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $1,260.00 / $1,716.00
| Facility | | $400.00 | $1,260.00 | $1,716.00 |