- 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 / $4,903.56 / $8,070.83
| Facility | | $1,310.70 | $4,903.56 | $8,070.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,568.94 / $2,568.94 / $2,568.94
| Facility | | $2,568.94 | $2,568.94 | $2,568.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $767.24 / $1,061.67 / $3,911.00
| Facility | | $767.24 | $1,061.67 | $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 |