- 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
- $4,645.45 / $4,645.45 / $4,645.45
| Facility | | $4,645.45 | $4,645.45 | $4,645.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.64 / $444.18 / $3,339.00
| Facility | | $311.64 | $444.18 | $3,339.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,343.00 / $3,339.00 / $5,838.00
| Facility | | $2,343.00 | $3,339.00 | $5,838.00 |