- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $188.46 / $1,386.00 / $5,634.00
| Facility | | $188.46 | $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
- $175.19 / $227.75 / $262.79
| Facility | | $175.19 | $227.75 | $262.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.58 / $402.00 / $848.27
| Facility | | $218.58 | $402.00 | $848.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.14 / $3,027.00 / $5,242.00
| Facility | | $988.14 | $3,027.00 | $5,242.00 |