- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,375.00 / $3,617.00 / $7,139.00
| Facility | | $1,375.00 | $3,617.00 | $7,139.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $601.16 / $2,197.38 / $3,616.69
| Facility | | $601.16 | $2,197.38 | $3,616.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,084.43 / $3,084.43 / $3,084.43
| Facility | | $3,084.43 | $3,084.43 | $3,084.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $287.56 / $389.52 / $3,533.00
| Facility | | $287.56 | $389.52 | $3,533.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,140.00 / $3,592.00 / $5,546.00
| Facility | | $2,140.00 | $3,592.00 | $5,546.00 |