- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $417.85 / $1,386.00 / $5,634.00
| Facility | | $417.85 | $1,386.00 | $5,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,636.00 / $3,840.00 / $7,036.00
| Facility | | $1,636.00 | $3,840.00 | $7,036.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $395.69 / $504.31 / $581.90
| Facility | | $395.69 | $504.31 | $581.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $402.00 / $486.30 / $848.27
| Facility | | $402.00 | $486.30 | $848.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $3,817.00 / $5,402.00
| Facility | | $900.00 | $3,817.00 | $5,402.00 |