- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $596.75 / $1,039.14 / $8,229.00
| Facility | | $596.75 | $1,039.14 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,320.00 / $4,334.00 / $11,433.00
| Facility | | $2,320.00 | $4,334.00 | $11,433.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $641.29 / $908.05 / $1,047.51
| Facility | | $641.29 | $908.05 | $1,047.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $815.73 / $815.73 / $946.62
| Facility | | $815.73 | $815.73 | $946.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $739.00 / $3,828.00 / $8,582.00
| Facility | | $739.00 | $3,828.00 | $8,582.00 |