- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,852.00 / $3,834.00 / $7,467.00
| Facility | | $1,852.00 | $3,834.00 | $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
- $154.51 / $263.92 / $571.16
| Facility | | $154.51 | $263.92 | $571.16 |
- 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 |