- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $241.25 / $1,941.00 / $7,212.00
| Facility | | $241.25 | $1,941.00 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,796.00 / $6,340.00 / $21,000.00
| Facility | | $2,796.00 | $6,340.00 | $21,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.59 / $287.52 / $331.76
| Facility | | $225.59 | $287.52 | $331.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,251.04 / $3,251.04 / $3,251.04
| Facility | | $3,251.04 | $3,251.04 | $3,251.04 |
- 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 |