- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $3,617.00 / $7,467.00
| Facility | | $1,671.00 | $3,617.00 | $7,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $438.60 / $1,651.20 / $2,700.74
| Facility | | $438.60 | $1,651.20 | $2,700.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,049.52 / $3,049.52 / $3,049.52
| Facility | | $3,049.52 | $3,049.52 | $3,049.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.16 / $980.61 / $4,702.00
| Facility | | $207.16 | $980.61 | $4,702.00 |
- 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 |