- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,170.00 / $3,437.00 / $6,060.00
| Facility | | $1,170.00 | $3,437.00 | $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 / $796.37 / $1,304.83
| Facility | | $333.00 | $796.37 | $1,304.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $236.56 / $482.45 / $1,043.74
| Facility | | $236.56 | $482.45 | $1,043.74 |
- 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 |