- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,170.00 / $2,736.07 / $6,060.00
| Facility | | $1,170.00 | $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 / $550.34 / $901.73
| Facility | | $333.00 | $550.34 | $901.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.55 / $149.53 / $1,900.00
| Facility | | $107.55 | $149.53 | $1,900.00 |
- 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 |