- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $441.74 / $2,629.00 / $7,365.00
| Facility | | $441.74 | $2,629.00 | $7,365.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $770.00 / $1,508.00 / $4,313.00
| Facility | | $770.00 | $1,508.00 | $4,313.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,231.00 / $9,308.00 / $10,577.00
| Facility | | $6,231.00 | $9,308.00 | $10,577.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $341.40 / $560.76 / $2,332.00
| Facility | | $341.40 | $560.76 | $2,332.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,300.00 / $2,332.00 / $3,074.00
| Facility | | $1,300.00 | $2,332.00 | $3,074.00 |