- 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
- $1,703.96 / $1,703.96 / $1,703.96
| Facility | | $1,703.96 | $1,703.96 | $1,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $384.45 / $600.20 / $3,801.00
| Facility | | $384.45 | $600.20 | $3,801.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,140.00 / $3,592.00 / $5,307.00
| Facility | | $2,140.00 | $3,592.00 | $5,307.00 |