- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,582.00 / $2,901.00 / $6,483.00
| Facility | | $1,582.00 | $2,901.00 | $6,483.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $781.60 / $2,918.30 / $5,113.62
| Facility | | $781.60 | $2,918.30 | $5,113.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,347.56 / $3,104.30 / $5,086.38
| Facility | | $2,347.56 | $3,104.30 | $5,086.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.78 / $627.59 / $1,455.76
| Facility | | $194.78 | $627.59 | $1,455.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $845.00 / $3,205.00 / $5,133.00
| Facility | | $845.00 | $3,205.00 | $5,133.00 |