- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,184.00 / $4,365.00 / $10,443.00
| Facility | | $1,184.00 | $4,365.00 | $10,443.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,554.74 / $5,677.50 / $8,972.21
| Facility | | $3,554.74 | $5,677.50 | $8,972.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,351.42 / $1,351.42 / $1,351.42
| Facility | | $1,351.42 | $1,351.42 | $1,351.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.12 / $810.67 / $4,393.26
| Facility | | $616.12 | $810.67 | $4,393.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.00 / $1,990.00 / $4,012.00
| Facility | | $575.00 | $1,990.00 | $4,012.00 |