- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $94.60 / $1,773.00 / $5,634.00
| Facility | | $94.60 | $1,773.00 | $5,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,682.00 / $3,677.00 / $5,445.00
| Facility | | $1,682.00 | $3,677.00 | $5,445.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.91 / $119.69 / $138.11
| Facility | | $93.91 | $119.69 | $138.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.52 / $640.52 / $640.52
| Facility | | $640.52 | $640.52 | $640.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,638.00 / $2,854.00 / $4,271.00
| Facility | | $1,638.00 | $2,854.00 | $4,271.00 |