- 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
- $2,214.21 / $2,214.21 / $2,214.21
| Facility | | $2,214.21 | $2,214.21 | $2,214.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.20 / $312.02 / $3,533.00
| Facility | | $218.20 | $312.02 | $3,533.00 |
- 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 |