- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.95 / $1,773.00 / $5,634.00
| Facility | | $165.95 | $1,773.00 | $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
- $152.32 / $198.02 / $228.48
| Facility | | $152.32 | $198.02 | $228.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $191.77 / $761.00 / $848.27
| Facility | | $191.77 | $761.00 | $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 |