- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $782.52 / $1,080.16 / $2,747.00
| Facility | | $782.52 | $1,080.16 | $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
- $771.59 / $1,106.28 / $1,276.17
| Facility | | $771.59 | $1,106.28 | $1,276.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $981.54 / $1,453.97 / $1,453.97
| Facility | | $981.54 | $1,453.97 | $1,453.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $599.00 / $2,723.00 / $6,295.00
| Facility | | $599.00 | $2,723.00 | $6,295.00 |