- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.92 / $637.00 / $2,747.00
| Facility | | $426.92 | $637.00 | $2,747.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,289.81 / $4,961.39 / $11,253.00
| Facility | | $2,289.81 | $4,961.39 | $11,253.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $458.60 / $664.50 / $830.62
| Facility | | $458.60 | $664.50 | $830.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $527.65 / $598.75 / $598.75
| Facility | | $527.65 | $598.75 | $598.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $668.00 / $1,895.00
| Facility | | $50.00 | $668.00 | $1,895.00 |