- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $4,521.00 / $8,104.00
| Facility | | $1,965.00 | $4,521.00 | $8,104.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $944.35 / $3,532.98 / $5,814.97
| Facility | | $944.35 | $3,532.98 | $5,814.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,750.38 / $5,750.38 / $5,750.38
| Facility | | $5,750.38 | $5,750.38 | $5,750.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.93 / $1,216.03 / $6,117.00
| Facility | | $831.93 | $1,216.03 | $6,117.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,878.00 / $4,545.00 / $7,217.00
| Facility | | $2,878.00 | $4,545.00 | $7,217.00 |