- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.38 / $1,093.73 / $2,747.00
| Facility | | $562.38 | $1,093.73 | $2,747.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,643.00 / $3,498.00 / $8,769.00
| Facility | | $1,643.00 | $3,498.00 | $8,769.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $613.04 / $875.76 / $1,010.25
| Facility | | $613.04 | $875.76 | $1,010.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $769.69 / $769.69 / $898.40
| Facility | | $769.69 | $769.69 | $898.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $973.00 / $4,639.00 / $12,296.00
| Facility | | $973.00 | $4,639.00 | $12,296.00 |