- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $4,474.00 / $8,239.00
| Facility | | $1,671.00 | $4,474.00 | $8,239.00 |
- 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
- $2,966.61 / $2,966.61 / $2,966.61
| Facility | | $2,966.61 | $2,966.61 | $2,966.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.71 / $487.96 / $3,787.00
| Facility | | $375.71 | $487.96 | $3,787.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,237.00 / $3,592.00 / $5,546.00
| Facility | | $2,237.00 | $3,592.00 | $5,546.00 |