- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $4,094.00 / $8,104.00
| Facility | | $1,965.00 | $4,094.00 | $8,104.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,341.54 / $4,934.39 / $8,070.83
| Facility | | $1,341.54 | $4,934.39 | $8,070.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,926.78 / $2,926.78 / $2,926.78
| Facility | | $2,926.78 | $2,926.78 | $2,926.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.07 / $501.34 / $6,117.00
| Facility | | $319.07 | $501.34 | $6,117.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $4,545.00 / $7,217.00
| Facility | | $2,912.00 | $4,545.00 | $7,217.00 |