- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,582.00 / $2,933.00 / $6,483.00
| Facility | | $1,582.00 | $2,933.00 | $6,483.00 |
- 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
- $1,459.33 / $1,459.33 / $1,459.33
| Facility | | $1,459.33 | $1,459.33 | $1,459.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.33 / $951.51 / $2,297.32
| Facility | | $154.33 | $951.51 | $2,297.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,357.00 / $2,405.00 / $4,850.00
| Facility | | $1,357.00 | $2,405.00 | $4,850.00 |