- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $377.40 / $637.00 / $2,747.00
| Facility | | $377.40 | $637.00 | $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
- $413.97 / $589.89 / $680.49
| Facility | | $413.97 | $589.89 | $680.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $522.64 / $522.64 / $597.52
| Facility | | $522.64 | $522.64 | $597.52 |
- 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 |