- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $4,873.00 / $9,112.00
| Facility | | $1,965.00 | $4,873.00 | $9,112.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,310.70 / $4,903.56 / $8,070.83
| Facility | | $1,310.70 | $4,903.56 | $8,070.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,374.52 / $5,374.52 / $5,374.52
| Facility | | $5,374.52 | $5,374.52 | $5,374.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $906.60 / $1,242.71 / $3,911.00
| Facility | | $906.60 | $1,242.71 | $3,911.00 |
- 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 |