- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,050.00 / $2,736.07 / $6,060.00
| Facility | | $1,050.00 | $2,736.07 | $6,060.00 |
- 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 / $971.62 / $1,591.99
| Facility | | $333.00 | $971.62 | $1,591.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $142.47 / $309.73 / $827.40
| Facility | | $142.47 | $309.73 | $827.40 |
- 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 |