- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $720.46 / $931.47 / $5,320.00
| Facility | | $720.46 | $931.47 | $5,320.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,241.00 / $9,565.00 / $11,253.00
| Facility | | $8,241.00 | $9,565.00 | $11,253.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $803.39 / $1,185.51 / $1,398.99
| Facility | | $803.39 | $1,185.51 | $1,398.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,002.98 / $1,043.05 / $1,043.05
| Facility | | $1,002.98 | $1,043.05 | $1,043.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $973.00 / $4,639.00 / $12,296.00
| Facility | | $973.00 | $4,639.00 | $12,296.00 |