- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $4,474.00 / $7,960.15
| Facility | | $1,965.00 | $4,474.00 | $7,960.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $830.45 / $3,228.01 / $5,113.62
| Facility | | $830.45 | $3,228.01 | $5,113.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $775.00 / $775.00 / $858.00
| Facility | | $775.00 | $775.00 | $858.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $792.95 / $1,755.44 / $5,107.00
| Facility | | $792.95 | $1,755.44 | $5,107.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,066.00 / $3,365.00 / $5,307.00
| Facility | | $2,066.00 | $3,365.00 | $5,307.00 |