- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $413.98 / $1,386.00 / $5,634.00
| Facility | | $413.98 | $1,386.00 | $5,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,411.35 / $7,572.00 / $18,942.00
| Facility | | $1,411.35 | $7,572.00 | $18,942.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $412.31 / $565.91 / $848.88
| Facility | | $412.31 | $565.91 | $848.88 |
- 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 |