- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $4,167.00 / $8,239.00
| Facility | | $1,671.00 | $4,167.00 | $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
- $3,049.52 / $3,049.52 / $3,049.52
| Facility | | $3,049.52 | $3,049.52 | $3,049.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $376.26 / $511.43 / $3,787.00
| Facility | | $376.26 | $511.43 | $3,787.00 |
- 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 |