- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $827.46 / $1,293.96 / $8,229.00
| Facility | | $827.46 | $1,293.96 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,104.00 / $5,280.00 / $12,101.00
| Facility | | $3,104.00 | $5,280.00 | $12,101.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.34 / $1,260.97 / $1,454.62
| Facility | | $875.34 | $1,260.97 | $1,454.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,120.18 / $1,120.18 / $1,274.13
| Facility | | $1,120.18 | $1,120.18 | $1,274.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $973.00 / $4,639.00 / $12,296.00
| Facility | | $973.00 | $4,639.00 | $12,296.00 |