- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.75 / $1,036.73 / $5,320.00
| Facility | | $489.75 | $1,036.73 | $5,320.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.00 / $2,316.00 / $4,389.00
| Facility | | $1,258.00 | $2,316.00 | $4,389.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $532.52 / $762.43 / $879.51
| Facility | | $532.52 | $762.43 | $879.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $671.81 / $671.81 / $1,020.84
| Facility | | $671.81 | $671.81 | $1,020.84 |
- 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 |