- 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 / $1,704.86 / $2,700.74
| Facility | | $438.60 | $1,704.86 | $2,700.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $150.00 / $150.00 / $453.00
| Facility | | $150.00 | $150.00 | $453.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $626.00 / $1,523.00 / $7,047.00
| Facility | | $626.00 | $1,523.00 | $7,047.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,856.00 / $4,545.00 / $7,217.00
| Facility | | $2,856.00 | $4,545.00 | $7,217.00 |