- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $659.25 / $1,051.70 / $8,229.00
| Facility | | $659.25 | $1,051.70 | $8,229.00 |
- 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
- $810.36 / $1,112.26 / $1,283.07
| Facility | | $810.36 | $1,112.26 | $1,283.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $973.78 / $973.78 / $973.78
| Facility | | $973.78 | $973.78 | $973.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $631.00 / $1,121.00 / $8,582.00
| Facility | | $631.00 | $1,121.00 | $8,582.00 |