- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,251.00 / $2,788.00 / $6,483.00
| Facility | | $1,251.00 | $2,788.00 | $6,483.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $438.60 / $1,640.88 / $2,700.74
| Facility | | $438.60 | $1,640.88 | $2,700.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,066.39 / $4,066.39 / $4,066.39
| Facility | | $4,066.39 | $4,066.39 | $4,066.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $210.09 / $772.10 / $4,655.00
| Facility | | $210.09 | $772.10 | $4,655.00 |
- 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 |