- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $236.18 / $3,067.00 / $7,365.00
| Facility | | $236.18 | $3,067.00 | $7,365.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $862.00 / $1,785.00 / $4,773.00
| Facility | | $862.00 | $1,785.00 | $4,773.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,213.00 / $2,213.00 / $2,213.00
| Facility | | $2,213.00 | $2,213.00 | $2,213.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.37 / $284.33 / $719.00
| Facility | | $153.37 | $284.33 | $719.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $180.00 / $747.00 / $1,300.00
| Facility | | $180.00 | $747.00 | $1,300.00 |