- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $372.72 / $2,318.00 / $16,042.00
| Facility | | $372.72 | $2,318.00 | $16,042.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,904.00 / $7,581.00 / $14,620.00
| Facility | | $2,904.00 | $7,581.00 | $14,620.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.73 / $510.22 / $765.33
| Facility | | $371.73 | $510.22 | $765.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,868.80 / $1,868.80 / $2,215.28
| Facility | | $1,868.80 | $1,868.80 | $2,215.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,400.00 / $3,874.00 / $5,490.00
| Facility | | $2,400.00 | $3,874.00 | $5,490.00 |