- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $542.38 / $1,941.00 / $7,212.00
| Facility | | $542.38 | $1,941.00 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,234.00 / $5,570.00 / $15,154.00
| Facility | | $2,234.00 | $5,570.00 | $15,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.22 / $689.29 / $795.33
| Facility | | $530.22 | $689.29 | $795.33 |
- 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 |