- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,582.00 / $2,933.00 / $6,483.00
| Facility | | $1,582.00 | $2,933.00 | $6,483.00 |
- 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
- $252.60 / $401.46 / $6,124.00
| Facility | | $252.60 | $401.46 | $6,124.00 |
- 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 |