- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,170.00 / $2,736.07 / $5,506.00
| Facility | | $1,170.00 | $2,736.07 | $5,506.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $438.60 / $1,640.88 / $2,700.74
| Facility | | $438.60 | $1,640.88 | $2,700.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $384.50 / $384.50 / $384.50
| Facility | | $384.50 | $384.50 | $384.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $116.66 / $223.51 / $1,117.00
| Facility | | $116.66 | $223.51 | $1,117.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $704.00 / $1,535.00 / $2,175.00
| Facility | | $704.00 | $1,535.00 | $2,175.00 |