- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $573.35 / $2,318.00 / $11,093.00
| Facility | | $573.35 | $2,318.00 | $11,093.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,318.00 / $6,474.00 / $13,758.00
| Facility | | $2,318.00 | $6,474.00 | $13,758.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $544.07 / $707.29 / $816.11
| Facility | | $544.07 | $707.29 | $816.11 |
- 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
- $2,462.00 / $3,782.00 / $5,402.00
| Facility | | $2,462.00 | $3,782.00 | $5,402.00 |