- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,095.35 / $4,375.00 / $16,467.00
| Facility | | $1,095.35 | $4,375.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,063.02 / $2,405.69 / $3,831.65
| Facility | | $1,063.02 | $2,405.69 | $3,831.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $890.00 / $890.00 / $1,084.33
| Facility | | $890.00 | $890.00 | $1,084.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $966.27 / $1,267.65 / $2,104.69
| Facility | | $966.27 | $1,267.65 | $2,104.69 |
- 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 |