- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $182.81 / $1,992.14 / $5,634.00
| Facility | | $182.81 | $1,992.14 | $5,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,636.00 / $3,840.00 / $7,747.00
| Facility | | $1,636.00 | $3,840.00 | $7,747.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $182.53 / $250.53 / $375.80
| Facility | | $182.53 | $250.53 | $375.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,123.45 / $1,123.45 / $1,331.74
| Facility | | $1,123.45 | $1,123.45 | $1,331.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,400.00 / $3,877.00 / $5,490.00
| Facility | | $2,400.00 | $3,877.00 | $5,490.00 |