- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,264.10 / $2,789.50 / $10,032.00
| Facility | | $1,264.10 | $2,789.50 | $10,032.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,052.27 / $5,047.99 / $10,416.10
| Facility | | $1,052.27 | $5,047.99 | $10,416.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $615.00 / $4,667.53
| Facility | | $375.00 | $615.00 | $4,667.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $497.40 / $682.35 / $993.49
| Facility | | $497.40 | $682.35 | $993.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $710.00 / $10,069.00 / $16,249.00
| Facility | | $710.00 | $10,069.00 | $16,249.00 |