- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $3,921.00 / $7,467.00
| Facility | | $1,965.00 | $3,921.00 | $7,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $632.79 / $2,362.71 / $4,140.09
| Facility | | $632.79 | $2,362.71 | $4,140.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $510.00 / $3,280.17 / $5,374.52
| Facility | | $510.00 | $3,280.17 | $5,374.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.50 / $731.58 / $6,014.00
| Facility | | $602.50 | $731.58 | $6,014.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,094.00 / $6,612.00 / $9,010.00
| Facility | | $4,094.00 | $6,612.00 | $9,010.00 |