- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $484.60 / $1,773.00 / $5,634.00
| Facility | | $484.60 | $1,773.00 | $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
- $486.54 / $620.10 / $715.50
| Facility | | $486.54 | $620.10 | $715.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,140.62 / $4,140.62 / $4,140.62
| Facility | | $4,140.62 | $4,140.62 | $4,140.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,400.00 / $3,870.00 / $5,490.00
| Facility | | $2,400.00 | $3,870.00 | $5,490.00 |