- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $253.52 / $3,408.48 / $7,954.00
| Facility | | $253.52 | $3,408.48 | $7,954.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,682.00 / $3,950.00 / $13,758.00
| Facility | | $1,682.00 | $3,950.00 | $13,758.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $252.94 / $347.17 / $520.76
| Facility | | $252.94 | $347.17 | $520.76 |
- 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 |