- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $310.45 / $350.00 / $4,846.00
| Facility | | $310.45 | $350.00 | $4,846.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,058.00 / $7,572.00 / $18,942.00
| Facility | | $1,058.00 | $7,572.00 | $18,942.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $284.70 / $370.12 / $427.07
| Facility | | $284.70 | $370.12 | $427.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.82 / $371.82 / $761.00
| Facility | | $371.82 | $371.82 | $761.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.00 / $5,076.00 / $10,396.00
| Facility | | $612.00 | $5,076.00 | $10,396.00 |