- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $3,819.00 / $7,467.00
| Facility | | $1,965.00 | $3,819.00 | $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
- $848.25 / $1,068.07 / $4,655.00
| Facility | | $848.25 | $1,068.07 | $4,655.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,338.31 / $3,847.00 / $7,217.00
| Facility | | $2,338.31 | $3,847.00 | $7,217.00 |