- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $601.62 / $929.29 / $2,747.00
| Facility | | $601.62 | $929.29 | $2,747.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,643.00 / $3,498.00 / $8,769.00
| Facility | | $1,643.00 | $3,498.00 | $8,769.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $654.44 / $939.23 / $1,083.48
| Facility | | $654.44 | $939.23 | $1,083.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $826.87 / $826.87 / $915.06
| Facility | | $826.87 | $826.87 | $915.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $973.00 / $4,639.00 / $12,296.00
| Facility | | $973.00 | $4,639.00 | $12,296.00 |