- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,274.00 / $4,387.00 / $10,439.00
| Facility | | $1,274.00 | $4,387.00 | $10,439.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $535.00 / $1,332.33 / $1,402.45
| Facility | | $535.00 | $1,332.33 | $1,402.45 |
- 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
- $492.83 / $770.14 / $5,562.00
| Facility | | $492.83 | $770.14 | $5,562.00 |
- 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 |