- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $382.41 / $3,474.85 / $10,561.00
| Facility | | $382.41 | $3,474.85 | $10,561.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.70 / $748.70 / $1,438.74
| Facility | | $748.70 | $748.70 | $1,438.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $382.41 / $523.71 / $797.86
| Facility | | $382.41 | $523.71 | $797.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,661.00 / $7,659.00 / $10,502.00
| Facility | | $1,661.00 | $7,659.00 | $10,502.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,491.44 / $4,754.80 / $26,542.00
| Facility | | $1,491.44 | $4,754.80 | $26,542.00 |