- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.91 / $1,082.03 / $2,747.00
| Facility | | $625.91 | $1,082.03 | $2,747.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,643.00 / $3,498.00 / $8,769.00
| Facility | | $1,643.00 | $3,498.00 | $8,769.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $675.27 / $968.62 / $1,117.36
| Facility | | $675.27 | $968.62 | $1,117.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $847.01 / $847.01 / $1,038.46
| Facility | | $847.01 | $847.01 | $1,038.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $739.00 / $3,828.00 / $8,582.00
| Facility | | $739.00 | $3,828.00 | $8,582.00 |