- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,070.00 / $2,788.00 / $6,483.00
| Facility | | $1,070.00 | $2,788.00 | $6,483.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $412.80 / $1,541.29 / $2,700.74
| Facility | | $412.80 | $1,541.29 | $2,700.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,418.48 / $4,520.43 / $7,406.71
| Facility | | $3,418.48 | $4,520.43 | $7,406.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $178.04 / $231.96 / $4,655.00
| Facility | | $178.04 | $231.96 | $4,655.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,424.00 / $4,352.00 / $7,217.00
| Facility | | $1,424.00 | $4,352.00 | $7,217.00 |