- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,008.00 / $2,640.00 / $6,060.00
| Facility | | $1,008.00 | $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
- $538.19 / $711.68 / $1,166.08
| Facility | | $538.19 | $711.68 | $1,166.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $166.20 / $384.91 / $966.00
| Facility | | $166.20 | $384.91 | $966.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,214.00 / $2,405.00 / $4,486.00
| Facility | | $1,214.00 | $2,405.00 | $4,486.00 |