- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.00 / $4,195.00 / $13,200.00
| Facility | | $1,346.00 | $4,195.00 | $13,200.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,554.74 / $5,647.22 / $8,922.54
| Facility | | $3,554.74 | $5,647.22 | $8,922.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,545.78 / $2,545.78 / $2,545.78
| Facility | | $2,545.78 | $2,545.78 | $2,545.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $353.35 / $475.00 / $4,705.00
| Facility | | $353.35 | $475.00 | $4,705.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.00 / $2,517.00 / $4,311.16
| Facility | | $660.00 | $2,517.00 | $4,311.16 |