- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.67 / $1,773.00 / $5,634.00
| Facility | | $97.67 | $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
- $101.17 / $128.94 / $148.79
| Facility | | $101.17 | $128.94 | $148.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $498.21 / $498.21 / $498.21
| Facility | | $498.21 | $498.21 | $498.21 |
- 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 |