- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $4,472.32 / $7,960.15
| Facility | | $1,965.00 | $4,472.32 | $7,960.15 |
- 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
- $3,104.53 / $3,104.53 / $3,104.53
| Facility | | $3,104.53 | $3,104.53 | $3,104.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $522.86 / $747.69 / $6,117.00
| Facility | | $522.86 | $747.69 | $6,117.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $3,981.00 / $7,217.00
| Facility | | $2,912.00 | $3,981.00 | $7,217.00 |