- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,389.00 / $2,788.00 / $6,483.00
| Facility | | $1,389.00 | $2,788.00 | $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
- $1,768.35 / $1,768.35 / $1,768.35
| Facility | | $1,768.35 | $1,768.35 | $1,768.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $187.93 / $263.10 / $3,770.00
| Facility | | $187.93 | $263.10 | $3,770.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,343.00 / $3,339.00 / $5,838.00
| Facility | | $2,343.00 | $3,339.00 | $5,838.00 |