- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $565.00 / $2,330.00 / $6,283.89
| Facility | | $565.00 | $2,330.00 | $6,283.89 |
- 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
- $73.93 / $263.83 / $858.75
| Facility | | $73.93 | $263.83 | $858.75 |
- 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 |