- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $3,770.00 / $7,467.00
| Facility | | $1,965.00 | $3,770.00 | $7,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.17 / $2,531.19 / $4,140.09
| Facility | | $688.17 | $2,531.19 | $4,140.09 |
- 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
- $469.76 / $764.34 / $6,124.00
| Facility | | $469.76 | $764.34 | $6,124.00 |
- 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 |