- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $4,094.00 / $7,960.15
| Facility | | $1,965.00 | $4,094.00 | $7,960.15 |
- 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
- $3,997.23 / $3,997.23 / $3,997.23
| Facility | | $3,997.23 | $3,997.23 | $3,997.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $498.75 / $783.68 / $6,117.00
| Facility | | $498.75 | $783.68 | $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 |