- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $277.57 / $1,386.00 / $5,634.00
| Facility | | $277.57 | $1,386.00 | $5,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,682.00 / $3,950.00 / $15,727.00
| Facility | | $1,682.00 | $3,950.00 | $15,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $279.12 / $355.75 / $410.48
| Facility | | $279.12 | $355.75 | $410.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,379.37 / $3,379.37 / $3,379.37
| Facility | | $3,379.37 | $3,379.37 | $3,379.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,364.00 / $6,094.00 / $10,413.00
| Facility | | $3,364.00 | $6,094.00 | $10,413.00 |