- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $365.19 / $1,001.45 / $2,747.00
| Facility | | $365.19 | $1,001.45 | $2,747.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,643.00 / $3,498.00 / $8,517.00
| Facility | | $1,643.00 | $3,498.00 | $8,517.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $340.88 / $464.79 / $548.48
| Facility | | $340.88 | $464.79 | $548.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $610.86 / $610.86 / $610.86
| Facility | | $610.86 | $610.86 | $610.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $973.00 / $4,639.00 / $15,075.00
| Facility | | $973.00 | $4,639.00 | $15,075.00 |