- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $596.17 / $1,045.57 / $8,229.00
| Facility | | $596.17 | $1,045.57 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $3,967.00 / $8,800.00
| Facility | | $2,088.00 | $3,967.00 | $8,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $647.76 / $929.91 / $1,072.72
| Facility | | $647.76 | $929.91 | $1,072.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $816.78 / $817.25 / $817.25
| Facility | | $816.78 | $817.25 | $817.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $739.00 / $3,828.00 / $8,582.00
| Facility | | $739.00 | $3,828.00 | $8,582.00 |