- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.27 / $828.28 / $4,846.00
| Facility | | $746.27 | $828.28 | $4,846.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,600.00 / $11,226.46 / $15,429.17
| Facility | | $4,600.00 | $11,226.46 | $15,429.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $690.23 / $897.30 / $1,035.34
| Facility | | $690.23 | $897.30 | $1,035.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $883.82
| Facility | | $761.00 | $761.00 | $883.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.00 / $5,076.00 / $10,396.00
| Facility | | $612.00 | $5,076.00 | $10,396.00 |