- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $685.31 / $1,619.72 / $16,467.00
| Facility | | $685.31 | $1,619.72 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $848.67 / $1,831.01 / $3,049.62
| Facility | | $848.67 | $1,831.01 | $3,049.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $580.00 / $684.40
| Facility | | $580.00 | $580.00 | $684.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $636.21 / $820.62 / $1,337.56
| Facility | | $636.21 | $820.62 | $1,337.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $358.00 / $1,134.00 / $2,922.00
| Facility | | $358.00 | $1,134.00 | $2,922.00 |