- 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
- $1,660.00 / $6,198.03 / $10,860.55
| Facility | | $1,660.00 | $6,198.03 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,502.85 / $4,632.01 / $7,589.51
| Facility | | $3,502.85 | $4,632.01 | $7,589.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $404.70 / $3,622.06 / $7,352.78
| Facility | | $404.70 | $3,622.06 | $7,352.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,472.00 / $7,088.00 / $11,396.00
| Facility | | $1,472.00 | $7,088.00 | $11,396.00 |