- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $936.00 / $3,617.00 / $6,329.00
| Facility | | $936.00 | $3,617.00 | $6,329.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $382.05 / $1,405.25 / $2,298.46
| Facility | | $382.05 | $1,405.25 | $2,298.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,683.01 / $2,683.01 / $2,683.01
| Facility | | $2,683.01 | $2,683.01 | $2,683.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.60 / $367.94 / $2,710.00
| Facility | | $225.60 | $367.94 | $2,710.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,068.00 / $1,958.00 / $3,268.00
| Facility | | $1,068.00 | $1,958.00 | $3,268.00 |