- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $451.85 / $1,129.44 / $2,747.00
| Facility | | $451.85 | $1,129.44 | $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
- $495.25 / $707.66 / $816.34
| Facility | | $495.25 | $707.66 | $816.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $624.92 / $624.92 / $1,112.14
| Facility | | $624.92 | $624.92 | $1,112.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.00 / $4,539.00 / $10,113.00
| Facility | | $842.00 | $4,539.00 | $10,113.00 |