- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $258.79 / $3,213.00 / $7,365.00
| Facility | | $258.79 | $3,213.00 | $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
- $141.26 / $256.70 / $1,007.94
| Facility | | $141.26 | $256.70 | $1,007.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,694.00 / $2,959.00 / $5,620.00
| Facility | | $1,694.00 | $2,959.00 | $5,620.00 |