- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $4,474.00 / $7,960.15
| Facility | | $1,965.00 | $4,474.00 | $7,960.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $830.45 / $3,106.86 / $5,113.62
| Facility | | $830.45 | $3,106.86 | $5,113.62 |
- 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
- $773.30 / $1,072.75 / $3,911.00
| Facility | | $773.30 | $1,072.75 | $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 |