- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,376.00 / $2,901.00 / $6,329.00
| Facility | | $1,376.00 | $2,901.00 | $6,329.00 |
- 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
- $4,100.10 / $4,100.10 / $4,100.10
| Facility | | $4,100.10 | $4,100.10 | $4,100.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $270.23 / $401.42 / $3,787.00
| Facility | | $270.23 | $401.42 | $3,787.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,343.00 / $3,339.00 / $5,838.00
| Facility | | $2,343.00 | $3,339.00 | $5,838.00 |