- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,184.00 / $4,595.00 / $7,310.00
| Facility | | $1,184.00 | $4,595.00 | $7,310.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,602.87 / $8,785.64 / $13,706.31
| Facility | | $5,602.87 | $8,785.64 | $13,706.31 |
- 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
- $685.09 / $953.34 / $6,840.79
| Facility | | $685.09 | $953.34 | $6,840.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,157.00 / $4,424.00 / $7,077.94
| Facility | | $1,157.00 | $4,424.00 | $7,077.94 |