- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,582.00 / $2,912.00 / $6,483.00
| Facility | | $1,582.00 | $2,912.00 | $6,483.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $587.35 / $2,197.38 / $3,616.69
| Facility | | $587.35 | $2,197.38 | $3,616.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,941.68 / $4,941.68 / $4,941.68
| Facility | | $4,941.68 | $4,941.68 | $4,941.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $790.06 / $997.55 / $3,801.00
| Facility | | $790.06 | $997.55 | $3,801.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,343.00 / $3,339.00 / $5,838.00
| Facility | | $2,343.00 | $3,339.00 | $5,838.00 |