- 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
- $578.00 / $768.56 / $1,336.83
| Facility | | $578.00 | $768.56 | $1,336.83 |
- 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
- $681.65 / $1,007.64 / $2,793.00
| Facility | | $681.65 | $1,007.64 | $2,793.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $525.00 / $1,353.00 / $2,793.00
| Facility | | $525.00 | $1,353.00 | $2,793.00 |