- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $3,617.00 / $7,562.14
| Facility | | $1,671.00 | $3,617.00 | $7,562.14 |
- 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
- $5,374.52 / $5,374.52 / $5,374.52
| Facility | | $5,374.52 | $5,374.52 | $5,374.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $773.92 / $1,069.57 / $3,790.00
| Facility | | $773.92 | $1,069.57 | $3,790.00 |
- 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 |