- 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
- $880.49 / $880.49 / $880.49
| Facility | | $880.49 | $880.49 | $880.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.83 / $141.94 / $2,594.00
| Facility | | $101.83 | $141.94 | $2,594.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,068.00 / $1,525.00 / $3,268.00
| Facility | | $1,068.00 | $1,525.00 | $3,268.00 |