- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $4,521.00 / $8,239.00
| Facility | | $1,671.00 | $4,521.00 | $8,239.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $830.45 / $3,126.40 / $5,113.62
| Facility | | $830.45 | $3,126.40 | $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
- $443.22 / $633.79 / $6,117.00
| Facility | | $443.22 | $633.79 | $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 |