- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $777.20 / $948.74 / $2,747.00
| Facility | | $777.20 | $948.74 | $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
- $838.39 / $1,207.49 / $1,392.93
| Facility | | $838.39 | $1,207.49 | $1,392.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $905.53 / $1,058.30 / $1,058.30
| Facility | | $905.53 | $1,058.30 | $1,058.30 |
- 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 |