- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,614.16 / $6,036.52 / $16,467.00
| Facility | | $2,614.16 | $6,036.52 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,017.26 / $6,017.26 / $6,017.26
| Facility | | $6,017.26 | $6,017.26 | $6,017.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $560.00 / $615.00
| Facility | | $100.00 | $560.00 | $615.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,029.00 / $2,633.48 / $4,487.14
| Facility | | $2,029.00 | $2,633.48 | $4,487.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $454.00 / $6,074.00 / $8,818.00
| Facility | | $454.00 | $6,074.00 | $8,818.00 |