- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,108.00 / $2,401.00 / $3,817.00
| Facility | | $1,108.00 | $2,401.00 | $3,817.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $850.00 / $1,723.00 / $3,236.00
| Facility | | $850.00 | $1,723.00 | $3,236.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $905.00 / $2,465.00 / $6,087.00
| Facility | | $905.00 | $2,465.00 | $6,087.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $462.51 / $1,126.68 / $2,441.32
| Facility | | $462.51 | $1,126.68 | $2,441.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,021.00 / $1,874.00 / $3,236.00
| Facility | | $1,021.00 | $1,874.00 | $3,236.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,402.00 / $2,402.00 / $2,402.00
| Facility | | $2,402.00 | $2,402.00 | $2,402.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $430.00 / $1,035.00 / $2,402.00
| Facility | | $430.00 | $1,035.00 | $2,402.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $909.78 / $1,648.95 / $2,612.66
| Facility | | $909.78 | $1,648.95 | $2,612.66 |