- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,560.30 / $5,192.00 / $9,062.00
| Facility | | $1,560.30 | $5,192.00 | $9,062.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,503.60 / $3,827.40 / $6,700.72
| Facility | | $1,503.60 | $3,827.40 | $6,700.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $780.00 / $2,581.96
| Facility | | $505.00 | $780.00 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $622.00 / $861.00 / $1,404.66
| Facility | | $622.00 | $861.00 | $1,404.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $729.00 / $6,607.00 / $8,667.00
| Facility | | $729.00 | $6,607.00 | $8,667.00 |