- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $811.98 / $1,243.00 / $13,304.00
| Facility | | $811.98 | $1,243.00 | $13,304.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,104.00 / $5,280.00 / $12,101.00
| Facility | | $3,104.00 | $5,280.00 | $12,101.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $792.06 / $1,087.14 / $1,254.09
| Facility | | $792.06 | $1,087.14 | $1,254.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $955.51 / $955.51 / $955.51
| Facility | | $955.51 | $955.51 | $955.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $719.00 / $1,298.00 / $10,113.00
| Facility | | $719.00 | $1,298.00 | $10,113.00 |