- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,008.00 / $2,640.00 / $6,060.00
| Facility | | $1,008.00 | $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
- $333.00 / $711.68 / $1,166.08
| Facility | | $333.00 | $711.68 | $1,166.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $200.43 / $390.75 / $801.60
| Facility | | $200.43 | $390.75 | $801.60 |
- 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 |