- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.30 / $787.00 / $3,740.00
| Facility | | $350.30 | $787.00 | $3,740.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,041.00 / $2,067.00 / $2,978.00
| Facility | | $1,041.00 | $2,067.00 | $2,978.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.67 / $543.41 / $626.87
| Facility | | $380.67 | $543.41 | $626.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $480.98 / $480.98 / $773.13
| Facility | | $480.98 | $480.98 | $773.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $523.00 / $1,450.00 / $5,301.00
| Facility | | $523.00 | $1,450.00 | $5,301.00 |