- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,108.00 / $3,600.00 / $10,439.00
| Facility | | $1,108.00 | $3,600.00 | $10,439.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $653.00 / $1,055.83 / $1,543.97
| Facility | | $653.00 | $1,055.83 | $1,543.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $596.00 / $1,098.00 / $2,437.00
| Facility | | $596.00 | $1,098.00 | $2,437.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $122.00 / $245.79 / $2,127.41
| Facility | | $122.00 | $245.79 | $2,127.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $816.00 / $2,081.00 / $3,918.00
| Facility | | $816.00 | $2,081.00 | $3,918.00 |