- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.92 / $787.00 / $3,740.00
| Facility | | $330.92 | $787.00 | $3,740.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,041.00 / $2,067.00 / $2,978.00
| Facility | | $1,041.00 | $2,067.00 | $2,978.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $306.85 / $421.18 / $485.85
| Facility | | $306.85 | $421.18 | $485.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $325.44 / $553.54 / $553.54
| Facility | | $325.44 | $553.54 | $553.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $523.00 / $1,450.00 / $5,301.00
| Facility | | $523.00 | $1,450.00 | $5,301.00 |