- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,375.00 / $2,897.00 / $6,483.00
| Facility | | $1,375.00 | $2,897.00 | $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
- $602.23 / $796.37 / $1,304.83
| Facility | | $602.23 | $796.37 | $1,304.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $191.31 / $781.10 / $1,640.48
| Facility | | $191.31 | $781.10 | $1,640.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $966.00 / $2,499.00 / $4,486.00
| Facility | | $966.00 | $2,499.00 | $4,486.00 |