- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $828.72 / $1,920.00 / $9,393.25
| Facility | | $828.72 | $1,920.00 | $9,393.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,320.00 / $4,334.00 / $11,433.00
| Facility | | $2,320.00 | $4,334.00 | $11,433.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.27 / $1,083.04 / $1,249.35
| Facility | | $791.27 | $1,083.04 | $1,249.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $804.47 / $954.32 / $954.32
| Facility | | $804.47 | $954.32 | $954.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $973.00 / $4,639.00 / $12,874.00
| Facility | | $973.00 | $4,639.00 | $12,874.00 |