- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $3,921.00 / $7,467.00
| Facility | | $1,965.00 | $3,921.00 | $7,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $438.60 / $1,640.88 / $2,700.74
| Facility | | $438.60 | $1,640.88 | $2,700.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,469.03 / $4,469.03 / $4,469.03
| Facility | | $4,469.03 | $4,469.03 | $4,469.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.01 / $794.11 / $4,655.00
| Facility | | $204.01 | $794.11 | $4,655.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,878.00 / $4,545.00 / $7,217.00
| Facility | | $2,878.00 | $4,545.00 | $7,217.00 |