- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $610.09 / $1,924.00 / $9,128.46
| Facility | | $610.09 | $1,924.00 | $9,128.46 |
- 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
- $552.95 / $776.48 / $895.74
| Facility | | $552.95 | $776.48 | $895.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $709.84 / $709.84 / $867.05
| Facility | | $709.84 | $709.84 | $867.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $523.00 / $1,450.00 / $5,301.00
| Facility | | $523.00 | $1,450.00 | $5,301.00 |