- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.62 / $1,194.00 / $13,304.00
| Facility | | $789.62 | $1,194.00 | $13,304.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,104.00 / $5,280.00 / $12,101.00
| Facility | | $3,104.00 | $5,280.00 | $12,101.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $877.53 / $1,197.24 / $1,381.09
| Facility | | $877.53 | $1,197.24 | $1,381.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,051.24 / $1,062.40 / $1,062.40
| Facility | | $1,051.24 | $1,062.40 | $1,062.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $599.00 / $2,723.00 / $6,295.00
| Facility | | $599.00 | $2,723.00 | $6,295.00 |