- 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 / $565.99 / $927.38
| Facility | | $333.00 | $565.99 | $927.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.65 / $163.18 / $594.79
| Facility | | $74.65 | $163.18 | $594.79 |
- 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 |