- 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
- $684.86 / $684.86 / $684.86
| Facility | | $684.86 | $684.86 | $684.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.56 / $155.10 / $2,108.55
| Facility | | $108.56 | $155.10 | $2,108.55 |
- 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 |