- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,170.00 / $3,819.00 / $11,883.00
| Facility | | $1,170.00 | $3,819.00 | $11,883.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $601.16 / $2,211.19 / $3,616.69
| Facility | | $601.16 | $2,211.19 | $3,616.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,926.78 / $2,926.78 / $2,926.78
| Facility | | $2,926.78 | $2,926.78 | $2,926.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $344.12 / $613.16 / $6,117.00
| Facility | | $344.12 | $613.16 | $6,117.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,878.00 / $4,545.00 / $7,217.00
| Facility | | $2,878.00 | $4,545.00 | $7,217.00 |