- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,070.00 / $2,771.00 / $5,506.00
| Facility | | $1,070.00 | $2,771.00 | $5,506.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $438.60 / $1,651.20 / $2,700.74
| Facility | | $438.60 | $1,651.20 | $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
- $483.20 / $663.22 / $3,790.00
| Facility | | $483.20 | $663.22 | $3,790.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,343.00 / $3,132.00 / $5,133.00
| Facility | | $2,343.00 | $3,132.00 | $5,133.00 |