- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $401.35 / $2,971.58 / $7,212.00
| Facility | | $401.35 | $2,971.58 | $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
- $392.77 / $510.60 / $589.16
| Facility | | $392.77 | $510.60 | $589.16 |
- 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
- $3,364.00 / $6,032.00 / $10,413.00
| Facility | | $3,364.00 | $6,032.00 | $10,413.00 |