- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $3,819.00 / $7,467.00
| Facility | | $1,965.00 | $3,819.00 | $7,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $830.45 / $3,106.86 / $5,113.62
| Facility | | $830.45 | $3,106.86 | $5,113.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,214.21 / $2,214.21 / $2,214.21
| Facility | | $2,214.21 | $2,214.21 | $2,214.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,269.33 / $1,929.21 / $3,911.00
| Facility | | $1,269.33 | $1,929.21 | $3,911.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,140.00 / $3,339.00 / $5,838.00
| Facility | | $2,140.00 | $3,339.00 | $5,838.00 |