- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,114.00 / $5,355.00 / $11,346.00
| Facility | | $2,114.00 | $5,355.00 | $11,346.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $448.92 / $1,704.86 / $2,700.74
| Facility | | $448.92 | $1,704.86 | $2,700.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,544.38 / $5,544.38 / $5,544.38
| Facility | | $5,544.38 | $5,544.38 | $5,544.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $221.14 / $388.84 / $9,978.00
| Facility | | $221.14 | $388.84 | $9,978.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,315.00 / $7,341.00 / $11,396.00
| Facility | | $5,315.00 | $7,341.00 | $11,396.00 |