- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $619.78 / $1,059.97 / $2,747.00
| Facility | | $619.78 | $1,059.97 | $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
- $675.70 / $969.93 / $1,118.89
| Facility | | $675.70 | $969.93 | $1,118.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $852.59 / $852.59 / $1,043.73
| Facility | | $852.59 | $852.59 | $1,043.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $523.00 / $1,450.00 / $5,301.00
| Facility | | $523.00 | $1,450.00 | $5,301.00 |