- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $725.24 / $1,114.71 / $2,747.00
| Facility | | $725.24 | $1,114.71 | $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
- $778.03 / $1,120.50 / $1,292.58
| Facility | | $778.03 | $1,120.50 | $1,292.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $984.92 / $984.92 / $1,097.63
| Facility | | $984.92 | $984.92 | $1,097.63 |
- 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 |