- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,170.00 / $2,736.07 / $5,506.00
| Facility | | $1,170.00 | $2,736.07 | $5,506.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $438.60 / $1,640.88 / $2,700.74
| Facility | | $438.60 | $1,640.88 | $2,700.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,805.45 / $8,805.45 / $8,805.45
| Facility | | $8,805.45 | $8,805.45 | $8,805.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.24 / $489.81 / $2,109.00
| Facility | | $350.24 | $489.81 | $2,109.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,578.00 / $2,567.00 / $5,029.00
| Facility | | $1,578.00 | $2,567.00 | $5,029.00 |