- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $710.43 / $3,214.00 / $5,691.00
| Facility | | $710.43 | $3,214.00 | $5,691.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $862.00 / $1,931.00 / $5,144.00
| Facility | | $862.00 | $1,931.00 | $5,144.00 |
- 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
- $482.17 / $785.31 / $3,532.00
| Facility | | $482.17 | $785.31 | $3,532.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,438.00 / $2,874.00 / $5,620.00
| Facility | | $1,438.00 | $2,874.00 | $5,620.00 |