- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,170.00 / $2,771.00 / $6,305.00
| Facility | | $1,170.00 | $2,771.00 | $6,305.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $412.80 / $1,541.29 / $2,700.74
| Facility | | $412.80 | $1,541.29 | $2,700.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $333.00 / $739.14 / $1,211.07
| Facility | | $333.00 | $739.14 | $1,211.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $391.08 / $534.69 / $1,109.98
| Facility | | $391.08 | $534.69 | $1,109.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $966.00 / $2,517.00 / $4,486.00
| Facility | | $966.00 | $2,517.00 | $4,486.00 |