- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $403.20 / $1,702.57 / $14,063.00
| Facility | | $403.20 | $1,702.57 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,411.35 / $9,011.00 / $20,784.00
| Facility | | $1,411.35 | $9,011.00 | $20,784.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.28 / $506.06 / $2,181.84
| Facility | | $389.28 | $506.06 | $2,181.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,116.34 / $2,116.34 / $2,508.71
| Facility | | $2,116.34 | $2,116.34 | $2,508.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,932.00 / $8,348.00 / $12,569.00
| Facility | | $3,932.00 | $8,348.00 | $12,569.00 |