- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $439.28 / $1,386.00 / $7,212.00
| Facility | | $439.28 | $1,386.00 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,234.00 / $5,126.00 / $8,388.00
| Facility | | $2,234.00 | $5,126.00 | $8,388.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $364.28 / $464.28 / $535.71
| Facility | | $364.28 | $464.28 | $535.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,314.83 / $1,314.83 / $1,314.83
| Facility | | $1,314.83 | $1,314.83 | $1,314.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,400.00 / $3,870.00 / $5,490.00
| Facility | | $2,400.00 | $3,870.00 | $5,490.00 |