- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,170.00 / $2,640.00 / $5,506.00
| Facility | | $1,170.00 | $2,640.00 | $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
- $1,211.07 / $1,211.07 / $1,211.07
| Facility | | $1,211.07 | $1,211.07 | $1,211.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $262.41 / $383.65 / $3,093.00
| Facility | | $262.41 | $383.65 | $3,093.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,263.02 / $2,482.00 / $4,486.00
| Facility | | $1,263.02 | $2,482.00 | $4,486.00 |