- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $816.75 / $2,303.00 / $6,681.00
| Facility | | $816.75 | $2,303.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,576.00 / $3,395.00 / $5,737.00
| Facility | | $1,576.00 | $3,395.00 | $5,737.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $475.00 / $1,759.11 / $2,213.00
| Facility | | $475.00 | $1,759.11 | $2,213.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,361.62 / $7,929.30 / $16,394.00
| Facility | | $3,361.62 | $7,929.30 | $16,394.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,236.00 / $4,027.00 / $7,669.00
| Facility | | $1,236.00 | $4,027.00 | $7,669.00 |