- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,038.00 / $2,260.00 / $5,506.00
| Facility | | $1,038.00 | $2,260.00 | $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
- $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
- $358.59 / $507.48 / $7,168.00
| Facility | | $358.59 | $507.48 | $7,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,613.00 / $6,477.00 / $9,010.00
| Facility | | $4,613.00 | $6,477.00 | $9,010.00 |