- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $668.07 / $4,498.00 / $12,154.00
| Facility | | $668.07 | $4,498.00 | $12,154.00 |
- 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
- $3,125.00 / $3,125.00 / $3,125.00
| Facility | | $3,125.00 | $3,125.00 | $3,125.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $454.10 / $720.80 / $2,516.00
| Facility | | $454.10 | $720.80 | $2,516.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,285.00 / $4,000.00 / $9,817.00
| Facility | | $2,285.00 | $4,000.00 | $9,817.00 |