- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,050.00 / $2,640.00 / $5,506.00
| Facility | | $1,050.00 | $2,640.00 | $5,506.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.30 / $3,300.84 / $5,432.89
| Facility | | $882.30 | $3,300.84 | $5,432.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,049.52 / $3,049.52 / $3,049.52
| Facility | | $3,049.52 | $3,049.52 | $3,049.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $142.72 / $221.22 / $3,790.00
| Facility | | $142.72 | $221.22 | $3,790.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,140.00 / $3,339.00 / $5,838.00
| Facility | | $2,140.00 | $3,339.00 | $5,838.00 |