- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $410.94 / $871.76 / $5,320.00
| Facility | | $410.94 | $871.76 | $5,320.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.00 / $2,316.00 / $4,389.00
| Facility | | $1,258.00 | $2,316.00 | $4,389.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $448.12 / $640.40 / $738.76
| Facility | | $448.12 | $640.40 | $738.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $565.41 / $565.41 / $858.41
| Facility | | $565.41 | $565.41 | $858.41 |
- 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 |