- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $460.93 / $1,941.00 / $7,212.00
| Facility | | $460.93 | $1,941.00 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,234.00 / $5,570.00 / $13,758.00
| Facility | | $2,234.00 | $5,570.00 | $13,758.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $461.46 / $633.37 / $950.06
| Facility | | $461.46 | $633.37 | $950.06 |
- 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
- $2,400.00 / $3,874.00 / $5,490.00
| Facility | | $2,400.00 | $3,874.00 | $5,490.00 |