- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $4,521.00 / $8,239.00
| Facility | | $1,965.00 | $4,521.00 | $8,239.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $830.45 / $3,106.86 / $5,113.62
| Facility | | $830.45 | $3,106.86 | $5,113.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,304.83 / $1,304.83 / $1,304.83
| Facility | | $1,304.83 | $1,304.83 | $1,304.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $296.52 / $407.01 / $3,134.00
| Facility | | $296.52 | $407.01 | $3,134.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,578.00 / $2,567.00 / $5,029.00
| Facility | | $1,578.00 | $2,567.00 | $5,029.00 |