- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,818.63 / $4,177.00 / $7,960.15
| Facility | | $1,818.63 | $4,177.00 | $7,960.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $830.45 / $3,126.40 / $5,113.62
| Facility | | $830.45 | $3,126.40 | $5,113.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $775.00 / $775.00 / $858.00
| Facility | | $775.00 | $775.00 | $858.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $802.18 / $1,867.55 / $7,047.00
| Facility | | $802.18 | $1,867.55 | $7,047.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,856.00 / $4,545.00 / $7,217.00
| Facility | | $2,856.00 | $4,545.00 | $7,217.00 |