- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.61 / $2,507.00 / $7,365.00
| Facility | | $208.61 | $2,507.00 | $7,365.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $1,451.00 / $3,553.00
| Facility | | $761.00 | $1,451.00 | $3,553.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,652.00 / $1,652.00 / $1,652.00
| Facility | | $1,652.00 | $1,652.00 | $1,652.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.15 / $172.44 / $585.66
| Facility | | $57.15 | $172.44 | $585.66 |
- 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 |