- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $474.47 / $3,130.00 / $7,194.00
| Facility | | $474.47 | $3,130.00 | $7,194.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $862.00 / $1,785.00 / $4,773.00
| Facility | | $862.00 | $1,785.00 | $4,773.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,530.00 / $2,530.00 / $2,530.00
| Facility | | $2,530.00 | $2,530.00 | $2,530.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.53 / $626.85 / $1,790.00
| Facility | | $389.53 | $626.85 | $1,790.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,694.00 / $2,959.00 / $5,620.00
| Facility | | $1,694.00 | $2,959.00 | $5,620.00 |