- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,170.00 / $2,640.00 / $6,060.00
| Facility | | $1,170.00 | $2,640.00 | $6,060.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $412.80 / $1,541.29 / $2,700.74
| Facility | | $412.80 | $1,541.29 | $2,700.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $333.00 / $3,280.17 / $5,374.52
| Facility | | $333.00 | $3,280.17 | $5,374.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $336.20 / $472.01 / $976.85
| Facility | | $336.20 | $472.01 | $976.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $845.00 / $3,311.00 / $5,133.00
| Facility | | $845.00 | $3,311.00 | $5,133.00 |