- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $4,888.00 / $9,808.06
| Facility | | $1,965.00 | $4,888.00 | $9,808.06 |
- 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
- $992.20 / $2,996.80 / $8,209.00
| Facility | | $992.20 | $2,996.80 | $8,209.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,500.00 / $6,455.00 / $9,010.00
| Facility | | $4,500.00 | $6,455.00 | $9,010.00 |