- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $986.94 / $3,213.00 / $7,365.00
| Facility | | $986.94 | $3,213.00 | $7,365.00 |
- 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
- $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
- $228.10 / $874.80 / $2,117.02
| Facility | | $228.10 | $874.80 | $2,117.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.00 / $2,363.00 / $5,999.30
| Facility | | $1,380.00 | $2,363.00 | $5,999.30 |