- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,582.00 / $2,901.00 / $6,483.00
| Facility | | $1,582.00 | $2,901.00 | $6,483.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $587.35 / $2,197.38 / $3,616.69
| Facility | | $587.35 | $2,197.38 | $3,616.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,342.58 / $6,342.58 / $6,342.58
| Facility | | $6,342.58 | $6,342.58 | $6,342.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.78 / $306.79 / $6,117.00
| Facility | | $223.78 | $306.79 | $6,117.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $4,545.00 / $7,217.00
| Facility | | $2,912.00 | $4,545.00 | $7,217.00 |