- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,402.00 / $3,761.00 / $5,006.00
| Facility | | $2,402.00 | $3,761.00 | $5,006.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,352.42 / $4,075.00 / $5,151.00
| Facility | | $2,352.42 | $4,075.00 | $5,151.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.00 / $1,348.00 / $6,755.00
| Facility | | $490.00 | $1,348.00 | $6,755.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.00 / $415.00 / $523.00
| Facility | | $380.00 | $415.00 | $523.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.00 / $3,346.00 / $5,255.00
| Facility | | $1,412.00 | $3,346.00 | $5,255.00 |