- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,170.00 / $2,640.00 / $5,506.00
| Facility | | $1,170.00 | $2,640.00 | $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
- $5,943.25 / $5,943.25 / $5,943.25
| Facility | | $5,943.25 | $5,943.25 | $5,943.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.44 / $1,064.96 / $6,117.00
| Facility | | $741.44 | $1,064.96 | $6,117.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $4,545.00 / $7,217.00
| Facility | | $2,912.00 | $4,545.00 | $7,217.00 |