- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $322.62 / $2,414.00 / $7,365.00
| Facility | | $322.62 | $2,414.00 | $7,365.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,114.00 / $4,050.00 / $9,663.00
| Facility | | $2,114.00 | $4,050.00 | $9,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,530.00 / $2,530.00 / $2,530.00
| Facility | | $2,530.00 | $2,530.00 | $2,530.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $233.86 / $409.08 / $958.04
| Facility | | $233.86 | $409.08 | $958.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.00 / $2,395.05 / $2,745.00
| Facility | | $1,380.00 | $2,395.05 | $2,745.00 |