- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $4,521.00 / $9,112.00
| Facility | | $1,965.00 | $4,521.00 | $9,112.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,310.70 / $5,094.77 / $8,070.83
| Facility | | $1,310.70 | $5,094.77 | $8,070.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,040.00 / $1,040.00 / $1,357.00
| Facility | | $1,040.00 | $1,040.00 | $1,357.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $542.37 / $837.52 / $3,952.86
| Facility | | $542.37 | $837.52 | $3,952.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,286.00 / $3,339.00 / $5,838.00
| Facility | | $2,286.00 | $3,339.00 | $5,838.00 |