- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,848.00 / $4,747.00 / $10,439.00
| Facility | | $1,848.00 | $4,747.00 | $10,439.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $984.20 / $1,450.76 / $3,055.34
| Facility | | $984.20 | $1,450.76 | $3,055.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $442.00 / $442.00 / $442.00
| Facility | | $442.00 | $442.00 | $442.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $642.26 / $1,004.69 / $5,565.00
| Facility | | $642.26 | $1,004.69 | $5,565.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,436.00 / $3,096.00 / $5,565.00
| Facility | | $1,436.00 | $3,096.00 | $5,565.00 |