- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,582.00 / $2,897.00 / $6,483.00
| Facility | | $1,582.00 | $2,897.00 | $6,483.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $587.35 / $2,197.38 / $3,616.69
| Facility | | $587.35 | $2,197.38 | $3,616.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,805.45 / $8,805.45 / $8,805.45
| Facility | | $8,805.45 | $8,805.45 | $8,805.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $955.66 / $1,295.05 / $7,168.00
| Facility | | $955.66 | $1,295.05 | $7,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,613.00 / $6,477.00 / $9,010.00
| Facility | | $4,613.00 | $6,477.00 | $9,010.00 |