- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,109.48 / $3,569.00 / $9,133.00
| Facility | | $1,109.48 | $3,569.00 | $9,133.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $853.62 / $853.62 / $853.62
| Facility | | $853.62 | $853.62 | $853.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $841.00 / $841.00 / $2,399.00
| Facility | | $841.00 | $841.00 | $2,399.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $192.81 / $856.31 / $1,632.97
| Facility | | $192.81 | $856.31 | $1,632.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $816.00 / $2,081.00 / $3,918.00
| Facility | | $816.00 | $2,081.00 | $3,918.00 |