- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,267.00 / $2,736.07 / $6,483.00
| Facility | | $1,267.00 | $2,736.07 | $6,483.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $552.79 / $2,064.02 / $3,616.69
| Facility | | $552.79 | $2,064.02 | $3,616.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.00 / $711.68 / $1,166.08
| Facility | | $446.00 | $711.68 | $1,166.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $238.76 / $434.94 / $927.50
| Facility | | $238.76 | $434.94 | $927.50 |
- 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 |