- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,150.00 / $5,511.00 / $9,257.00
| Facility | | $1,150.00 | $5,511.00 | $9,257.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,997.28 / $12,508.22 / $19,618.43
| Facility | | $7,997.28 | $12,508.22 | $19,618.43 |
- 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
- $496.63 / $682.32 / $6,184.00
| Facility | | $496.63 | $682.32 | $6,184.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.00 / $3,317.00 / $5,543.93
| Facility | | $884.00 | $3,317.00 | $5,543.93 |