- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $329.45 / $1,941.00 / $7,212.00
| Facility | | $329.45 | $1,941.00 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,804.00 / $5,126.00 / $8,240.00
| Facility | | $1,804.00 | $5,126.00 | $8,240.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.64 / $420.73 / $485.46
| Facility | | $323.64 | $420.73 | $485.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $949.22 / $949.22 / $1,125.20
| Facility | | $949.22 | $949.22 | $1,125.20 |
- 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 |