- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $527.29 / $1,192.00 / $5,925.97
| Facility | | $527.29 | $1,192.00 | $5,925.97 |
- 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
- $593.45 / $853.87 / $1,007.63
| Facility | | $593.45 | $853.87 | $1,007.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $749.68 / $749.68 / $1,118.94
| Facility | | $749.68 | $749.68 | $1,118.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,168.00 / $6,186.00 / $16,855.00
| Facility | | $1,168.00 | $6,186.00 | $16,855.00 |