- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $192.93 / $2,090.76 / $7,212.00
| Facility | | $192.93 | $2,090.76 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,266.00 / $5,570.00 / $13,810.27
| Facility | | $2,266.00 | $5,570.00 | $13,810.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $180.99 / $230.67 / $266.16
| Facility | | $180.99 | $230.67 | $266.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,158.09 / $2,158.09 / $2,158.09
| Facility | | $2,158.09 | $2,158.09 | $2,158.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,932.00 / $8,025.00 / $11,038.00
| Facility | | $3,932.00 | $8,025.00 | $11,038.00 |