- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,082.00 / $2,640.00 / $6,060.00
| Facility | | $1,082.00 | $2,640.00 | $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
- $111.13 / $146.94 / $240.78
| Facility | | $111.13 | $146.94 | $240.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.23 / $133.41 / $263.00
| Facility | | $101.23 | $133.41 | $263.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $285.00 / $1,488.00 / $2,057.00
| Facility | | $285.00 | $1,488.00 | $2,057.00 |