- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $198.53 / $2,274.71 / $7,212.00
| Facility | | $198.53 | $2,274.71 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,614.00 / $7,572.00 / $18,942.00
| Facility | | $1,614.00 | $7,572.00 | $18,942.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $185.72 / $236.70 / $942.12
| Facility | | $185.72 | $236.70 | $942.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,958.13 / $2,958.13 / $2,958.13
| Facility | | $2,958.13 | $2,958.13 | $2,958.13 |
- 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 |