- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,361.00 / $3,569.00 / $10,439.00
| Facility | | $1,361.00 | $3,569.00 | $10,439.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $592.62 / $767.60 / $1,277.76
| Facility | | $592.62 | $767.60 | $1,277.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.00 / $626.00 / $2,437.00
| Facility | | $530.00 | $626.00 | $2,437.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $118.41 / $183.62 / $2,776.25
| Facility | | $118.41 | $183.62 | $2,776.25 |
- 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 |