- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.87 / $1,003.95 / $5,320.00
| Facility | | $630.87 | $1,003.95 | $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
- $672.28 / $964.75 / $1,112.91
| Facility | | $672.28 | $964.75 | $1,112.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.42 / $851.42 / $988.57
| Facility | | $851.42 | $851.42 | $988.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.00 / $4,539.00 / $10,113.00
| Facility | | $842.00 | $4,539.00 | $10,113.00 |