- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,395.45 / $4,450.00 / $8,031.00
| Facility | | $1,395.45 | $4,450.00 | $8,031.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $816.76 / $8,931.00 / $11,908.00
| Facility | | $816.76 | $8,931.00 | $11,908.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $767.00 / $1,924.63 / $2,215.84
| Facility | | $767.00 | $1,924.63 | $2,215.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $837.20 / $1,077.65 / $1,552.85
| Facility | | $837.20 | $1,077.65 | $1,552.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $911.00 / $5,307.00 / $8,879.00
| Facility | | $911.00 | $5,307.00 | $8,879.00 |