- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $4,182.00 / $7,960.15
| Facility | | $1,965.00 | $4,182.00 | $7,960.15 |
- 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
- $2,966.61 / $2,966.61 / $2,966.61
| Facility | | $2,966.61 | $2,966.61 | $2,966.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $637.95 / $874.56 / $3,801.00
| Facility | | $637.95 | $874.56 | $3,801.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,237.00 / $3,627.00 / $5,546.00
| Facility | | $2,237.00 | $3,627.00 | $5,546.00 |