- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $536.48 / $1,007.85 / $2,747.00
| Facility | | $536.48 | $1,007.85 | $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
- $575.53 / $810.32 / $934.76
| Facility | | $575.53 | $810.32 | $934.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $737.44 / $737.44 / $992.41
| Facility | | $737.44 | $737.44 | $992.41 |
- 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 |