- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $701.52 / $2,303.00 / $5,417.90
| Facility | | $701.52 | $2,303.00 | $5,417.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,565.00 / $3,323.00 / $5,737.00
| Facility | | $1,565.00 | $3,323.00 | $5,737.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $475.00 / $1,754.69 / $2,213.00
| Facility | | $475.00 | $1,754.69 | $2,213.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,882.70 / $7,909.30 / $16,394.00
| Facility | | $2,882.70 | $7,909.30 | $16,394.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,001.00 / $3,351.00 / $6,285.00
| Facility | | $1,001.00 | $3,351.00 | $6,285.00 |