- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.35 / $1,773.00 / $5,634.00
| Facility | | $307.35 | $1,773.00 | $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
- $301.87 / $392.43 / $452.81
| Facility | | $301.87 | $392.43 | $452.81 |
- 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 / $3,874.00 / $5,490.00
| Facility | | $2,400.00 | $3,874.00 | $5,490.00 |