- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.46 / $1,947.50 / $4,922.05
| Facility | | $761.46 | $1,947.50 | $4,922.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $498.00 / $1,362.98 / $2,709.73
| Facility | | $498.00 | $1,362.98 | $2,709.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $396.00 / $634.37 / $1,013.71
| Facility | | $396.00 | $634.37 | $1,013.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $393.00 / $661.00 / $4,824.00
| Facility | | $393.00 | $661.00 | $4,824.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,214.38 / $7,929.30 / $16,394.00
| Facility | | $3,214.38 | $7,929.30 | $16,394.00 |