- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $594.45 / $843.61 / $5,320.00
| Facility | | $594.45 | $843.61 | $5,320.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.00 / $2,316.00 / $4,229.00
| Facility | | $1,258.00 | $2,316.00 | $4,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $637.37 / $916.94 / $1,057.77
| Facility | | $637.37 | $916.94 | $1,057.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $804.68 / $804.68 / $830.69
| Facility | | $804.68 | $804.68 | $830.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $391.00 / $950.00 / $3,394.00
| Facility | | $391.00 | $950.00 | $3,394.00 |