- 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
- $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
- $620.44 / $905.36 / $9,251.00
| Facility | | $620.44 | $905.36 | $9,251.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,315.00 / $7,341.00 / $11,396.00
| Facility | | $5,315.00 | $7,341.00 | $11,396.00 |