- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.74 / $2,507.00 / $7,365.00
| Facility | | $307.74 | $2,507.00 | $7,365.00 |
- 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
- $1,693.00 / $2,769.00 / $4,641.00
| Facility | | $1,693.00 | $2,769.00 | $4,641.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.55 / $272.72 / $858.12
| Facility | | $105.55 | $272.72 | $858.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,185.00 / $2,332.00 / $3,041.00
| Facility | | $1,185.00 | $2,332.00 | $3,041.00 |