- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $852.71 / $944.96 / $4,846.00
| Facility | | $852.71 | $944.96 | $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
- $803.22 / $1,023.71 / $1,181.21
| Facility | | $803.22 | $1,023.71 | $1,181.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $1,016.10
| Facility | | $761.00 | $761.00 | $1,016.10 |
- 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 |