- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $774.08 / $3,606.00 / $7,212.00
| Facility | | $774.08 | $3,606.00 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,153.00 / $7,572.00 / $16,778.00
| Facility | | $1,153.00 | $7,572.00 | $16,778.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $709.75 / $922.68 / $1,064.63
| Facility | | $709.75 | $922.68 | $1,064.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $890.93
| Facility | | $761.00 | $761.00 | $890.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,500.00 / $5,995.00 / $9,243.00
| Facility | | $1,500.00 | $5,995.00 | $9,243.00 |