- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $4,521.00 / $7,963.00
| Facility | | $1,965.00 | $4,521.00 | $7,963.00 |
- 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
- $5,374.52 / $5,374.52 / $5,374.52
| Facility | | $5,374.52 | $5,374.52 | $5,374.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,009.72 / $1,400.58 / $7,168.00
| Facility | | $1,009.72 | $1,400.58 | $7,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,637.00 / $5,596.00 / $8,586.00
| Facility | | $4,637.00 | $5,596.00 | $8,586.00 |