- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,250.00 / $2,205.00 / $12,878.00
| Facility | | $1,250.00 | $2,205.00 | $12,878.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,384.76 / $1,400.00 / $2,201.88
| Facility | | $1,384.76 | $1,400.00 | $2,201.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,150.00 / $1,350.00 / $3,200.00
| Facility | | $1,150.00 | $1,350.00 | $3,200.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,583.71 / $1,610.00 / $2,532.16
| Facility | | $1,583.71 | $1,610.00 | $2,532.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $532.00 / $808.00 / $1,785.00
| Facility | | $532.00 | $808.00 | $1,785.00 |