- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.64 / $1,026.35 / $2,747.00
| Facility | | $562.64 | $1,026.35 | $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
- $602.09 / $847.88 / $978.10
| Facility | | $602.09 | $847.88 | $978.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $772.86 / $772.86 / $1,010.63
| Facility | | $772.86 | $772.86 | $1,010.63 |
- 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 |