- 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
- $343.00 / $663.27 / $2,124.36
| Facility | | $343.00 | $663.27 | $2,124.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $617.00 / $1,535.00 / $2,175.00
| Facility | | $617.00 | $1,535.00 | $2,175.00 |