- 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 / $1,571.83 / $2,575.42
| Facility | | $510.00 | $1,571.83 | $2,575.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $594.09 / $754.18 / $3,592.00
| Facility | | $594.09 | $754.18 | $3,592.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $845.00 / $3,311.00 / $5,133.00
| Facility | | $845.00 | $3,311.00 | $5,133.00 |