- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $565.10 / $1,031.40 / $2,747.00
| Facility | | $565.10 | $1,031.40 | $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
- $606.41 / $854.01 / $985.17
| Facility | | $606.41 | $854.01 | $985.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $777.32 / $777.32 / $1,015.59
| Facility | | $777.32 | $777.32 | $1,015.59 |
- 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 |