- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,170.00 / $3,055.00 / $6,305.00
| Facility | | $1,170.00 | $3,055.00 | $6,305.00 |
- 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 / $2,109.10 / $3,455.73
| Facility | | $333.00 | $2,109.10 | $3,455.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $643.54 / $815.73 / $3,612.00
| Facility | | $643.54 | $815.73 | $3,612.00 |
- 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 |