- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,070.00 / $3,936.00 / $7,467.00
| Facility | | $1,070.00 | $3,936.00 | $7,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $672.35 / $2,531.19 / $4,140.09
| Facility | | $672.35 | $2,531.19 | $4,140.09 |
- 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
- $177.57 / $275.58 / $3,339.00
| Facility | | $177.57 | $275.58 | $3,339.00 |
- 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 |