- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,162.00 / $3,055.00 / $5,506.00
| Facility | | $1,162.00 | $3,055.00 | $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
- $1,304.83 / $1,304.83 / $1,304.83
| Facility | | $1,304.83 | $1,304.83 | $1,304.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $86.53 / $168.43 / $2,017.00
| Facility | | $86.53 | $168.43 | $2,017.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,578.00 / $2,567.00 / $5,029.00
| Facility | | $1,578.00 | $2,567.00 | $5,029.00 |