- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $310.20 / $1,773.00 / $5,634.00
| Facility | | $310.20 | $1,773.00 | $5,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,682.00 / $3,840.00 / $7,747.00
| Facility | | $1,682.00 | $3,840.00 | $7,747.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $289.60 / $369.10 / $425.88
| Facility | | $289.60 | $369.10 | $425.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $881.00 / $881.00 / $881.00
| Facility | | $881.00 | $881.00 | $881.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,241.41 / $3,027.00 / $5,402.00
| Facility | | $1,241.41 | $3,027.00 | $5,402.00 |