- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,144.00 / $6,028.00 / $11,651.00
| Facility | | $3,144.00 | $6,028.00 | $11,651.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $974.73 / $1,333.38 / $1,415.67
| Facility | | $974.73 | $1,333.38 | $1,415.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,377.50 / $7,080.70 / $10,036.00
| Facility | | $4,377.50 | $7,080.70 | $10,036.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.58 / $38.03 / $947.10
| Facility | | $4.58 | $38.03 | $947.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $650.00 / $650.00 / $650.00
| Facility | | $650.00 | $650.00 | $650.00 |