- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.00 / $4,826.00 / $14,100.00
| Facility | | $1,346.00 | $4,826.00 | $14,100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,064.77 / $6,492.10 / $10,259.57
| Facility | | $4,064.77 | $6,492.10 | $10,259.57 |
- 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
- $477.44 / $671.83 / $5,962.62
| Facility | | $477.44 | $671.83 | $5,962.62 |
- 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 |