- 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
- $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
- $308.13 / $426.20 / $1,487.00
| Facility | | $308.13 | $426.20 | $1,487.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,068.00 / $1,711.00 / $3,268.00
| Facility | | $1,068.00 | $1,711.00 | $3,268.00 |