- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $351.02 / $896.00 / $2,033.00
| Facility | | $351.02 | $896.00 | $2,033.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $172.36 / $623.48 / $1,036.96
| Facility | | $172.36 | $623.48 | $1,036.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,293.95 / $1,293.95 / $1,293.95
| Facility | | $1,293.95 | $1,293.95 | $1,293.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $172.92 / $327.83 / $1,424.00
| Facility | | $172.92 | $327.83 | $1,424.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $704.00 / $1,535.00 / $2,175.00
| Facility | | $704.00 | $1,535.00 | $2,175.00 |