- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $3,936.00 / $7,467.00
| Facility | | $1,671.00 | $3,936.00 | $7,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $632.79 / $2,362.71 / $4,140.09
| Facility | | $632.79 | $2,362.71 | $4,140.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $510.00 / $1,571.83 / $2,575.42
| Facility | | $510.00 | $1,571.83 | $2,575.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.33 / $222.01 / $845.00
| Facility | | $115.33 | $222.01 | $845.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,047.00 / $2,971.00 / $5,107.00
| Facility | | $2,047.00 | $2,971.00 | $5,107.00 |