- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,184.00 / $4,192.00 / $13,200.00
| Facility | | $1,184.00 | $4,192.00 | $13,200.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,653.03 / $7,392.01 / $11,679.29
| Facility | | $4,653.03 | $7,392.01 | $11,679.29 |
- 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
- $327.48 / $503.18 / $4,705.00
| Facility | | $327.48 | $503.18 | $4,705.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.00 / $2,900.00 / $5,543.93
| Facility | | $884.00 | $2,900.00 | $5,543.93 |