- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $546.04 / $859.38 / $5,320.00
| Facility | | $546.04 | $859.38 | $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
- $588.30 / $830.96 / $958.57
| Facility | | $588.30 | $830.96 | $958.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $749.37 / $749.37 / $846.21
| Facility | | $749.37 | $749.37 | $846.21 |
- 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 |