- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.26 / $2,425.23 / $6,284.00
| Facility | | $323.26 | $2,425.23 | $6,284.00 |
- 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
- $91.75 / $300.86 / $1,048.18
| Facility | | $91.75 | $300.86 | $1,048.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,169.00 / $2,306.00 / $3,041.00
| Facility | | $1,169.00 | $2,306.00 | $3,041.00 |