- 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
- $448.92 / $1,651.20 / $2,700.74
| Facility | | $448.92 | $1,651.20 | $2,700.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,165.05 / $1,165.05 / $1,165.05
| Facility | | $1,165.05 | $1,165.05 | $1,165.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $62.14 / $129.35 / $1,627.00
| Facility | | $62.14 | $129.35 | $1,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,068.00 / $1,958.00 / $3,268.00
| Facility | | $1,068.00 | $1,958.00 | $3,268.00 |