- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,091.56 / $4,450.00 / $8,031.00
| Facility | | $1,091.56 | $4,450.00 | $8,031.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.57 / $8,848.00 / $11,797.00
| Facility | | $612.57 | $8,848.00 | $11,797.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $767.00 / $1,121.14 / $1,290.78
| Facility | | $767.00 | $1,121.14 | $1,290.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $626.58 / $809.30 / $1,135.28
| Facility | | $626.58 | $809.30 | $1,135.28 |
- 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 |