- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,217.00 / $2,912.00 / $6,483.00
| Facility | | $1,217.00 | $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
- $4,645.45 / $4,645.45 / $4,645.45
| Facility | | $4,645.45 | $4,645.45 | $4,645.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $938.57 / $1,374.14 / $6,117.00
| Facility | | $938.57 | $1,374.14 | $6,117.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $4,545.00 / $7,217.00
| Facility | | $2,912.00 | $4,545.00 | $7,217.00 |