- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,582.00 / $3,008.00 / $6,483.00
| Facility | | $1,582.00 | $3,008.00 | $6,483.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $552.79 / $2,064.02 / $3,616.69
| Facility | | $552.79 | $2,064.02 | $3,616.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.00 / $1,567.87 / $2,568.94
| Facility | | $446.00 | $1,567.87 | $2,568.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.66 / $238.65 / $494.26
| Facility | | $138.66 | $238.65 | $494.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $845.00 / $3,311.00 / $5,133.00
| Facility | | $845.00 | $3,311.00 | $5,133.00 |