- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,125.00 / $2,736.07 / $6,305.00
| Facility | | $1,125.00 | $2,736.07 | $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
- $1,188.66 / $1,571.83 / $2,575.42
| Facility | | $1,188.66 | $1,571.83 | $2,575.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $180.43 / $238.07 / $2,109.00
| Facility | | $180.43 | $238.07 | $2,109.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $966.00 / $2,499.00 / $4,486.00
| Facility | | $966.00 | $2,499.00 | $4,486.00 |