- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.37 / $1,064.75 / $2,747.00
| Facility | | $597.37 | $1,064.75 | $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
- $647.44 / $923.55 / $1,065.39
| Facility | | $647.44 | $923.55 | $1,065.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $799.78 / $799.78 / $960.15
| Facility | | $799.78 | $799.78 | $960.15 |
- 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 |