- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,582.00 / $2,933.00 / $6,483.00
| Facility | | $1,582.00 | $2,933.00 | $6,483.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $901.37 / $3,503.66 / $5,550.29
| Facility | | $901.37 | $3,503.66 | $5,550.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $250.00 / $250.00 / $607.00
| Facility | | $250.00 | $250.00 | $607.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $681.16 / $1,785.63 / $5,107.00
| Facility | | $681.16 | $1,785.63 | $5,107.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,066.00 / $3,365.00 / $5,307.00
| Facility | | $2,066.00 | $3,365.00 | $5,307.00 |