- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $4,094.00 / $7,467.00
| Facility | | $1,965.00 | $4,094.00 | $7,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.17 / $2,822.29 / $4,630.78
| Facility | | $688.17 | $2,822.29 | $4,630.78 |
- 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
- $312.64 / $988.16 / $5,541.00
| Facility | | $312.64 | $988.16 | $5,541.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,683.74 / $3,981.00 / $7,217.00
| Facility | | $2,683.74 | $3,981.00 | $7,217.00 |