- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $590.12 / $2,507.00 / $7,365.00
| Facility | | $590.12 | $2,507.00 | $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
- $83.28 / $590.12 / $1,434.04
| Facility | | $83.28 | $590.12 | $1,434.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $825.00 / $2,261.00 / $3,041.00
| Facility | | $825.00 | $2,261.00 | $3,041.00 |