- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.00 / $952.39 / $2,747.00
| Facility | | $612.00 | $952.39 | $2,747.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,643.00 / $3,498.00 / $8,517.00
| Facility | | $1,643.00 | $3,498.00 | $8,517.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $811.65 / $1,133.76 / $1,307.88
| Facility | | $811.65 | $1,133.76 | $1,307.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.38 / $1,490.09 / $1,490.09
| Facility | | $537.38 | $1,490.09 | $1,490.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.00 / $4,539.00 / $10,113.00
| Facility | | $842.00 | $4,539.00 | $10,113.00 |