- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $637.00 / $807.26 / $8,229.00
| Facility | | $637.00 | $807.26 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,643.00 / $3,428.00 / $8,517.00
| Facility | | $1,643.00 | $3,428.00 | $8,517.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $646.52 / $902.34 / $1,031.25
| Facility | | $646.52 | $902.34 | $1,031.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $700.45 / $822.07 / $1,728.48
| Facility | | $700.45 | $822.07 | $1,728.48 |
- 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 |