- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $395.45 / $824.00 / $5,634.00
| Facility | | $395.45 | $824.00 | $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
- $395.48 / $542.82 / $814.23
| Facility | | $395.48 | $542.82 | $814.23 |
- 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
- $933.00 / $2,252.00 / $4,426.00
| Facility | | $933.00 | $2,252.00 | $4,426.00 |