- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $607.64 / $818.58 / $5,320.00
| Facility | | $607.64 | $818.58 | $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
- $593.74 / $810.59 / $935.07
| Facility | | $593.74 | $810.59 | $935.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $679.55 / $1,065.33 / $1,065.33
| Facility | | $679.55 | $1,065.33 | $1,065.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $599.00 / $2,723.00 / $6,295.00
| Facility | | $599.00 | $2,723.00 | $6,295.00 |