- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $552.11 / $873.27 / $2,747.00
| Facility | | $552.11 | $873.27 | $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
- $593.60 / $838.64 / $967.44
| Facility | | $593.60 | $838.64 | $967.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.83 / $756.83 / $859.90
| Facility | | $756.83 | $756.83 | $859.90 |
- 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 |