- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $287.48 / $2,483.00 / $5,687.00
| Facility | | $287.48 | $2,483.00 | $5,687.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $770.00 / $1,508.00 / $3,523.00
| Facility | | $770.00 | $1,508.00 | $3,523.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,213.00 / $2,769.00 / $4,641.00
| Facility | | $2,213.00 | $2,769.00 | $4,641.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $227.13 / $386.51 / $2,745.00
| Facility | | $227.13 | $386.51 | $2,745.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.00 / $2,332.00 / $3,041.00
| Facility | | $1,380.00 | $2,332.00 | $3,041.00 |