- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $589.21 / $1,149.16 / $2,747.00
| Facility | | $589.21 | $1,149.16 | $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
- $636.58 / $914.56 / $1,055.01
| Facility | | $636.58 | $914.56 | $1,055.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $803.86 / $803.86 / $1,131.56
| Facility | | $803.86 | $803.86 | $1,131.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $739.00 / $2,396.50 / $8,582.00
| Facility | | $739.00 | $2,396.50 | $8,582.00 |