- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $370.65 / $1,386.00 / $7,212.00
| Facility | | $370.65 | $1,386.00 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,234.00 / $5,126.00 / $8,388.00
| Facility | | $2,234.00 | $5,126.00 | $8,388.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.37 / $391.74 / $452.01
| Facility | | $307.37 | $391.74 | $452.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,314.83 / $1,314.83 / $1,314.83
| Facility | | $1,314.83 | $1,314.83 | $1,314.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,533.00 / $3,027.00 / $5,402.00
| Facility | | $1,533.00 | $3,027.00 | $5,402.00 |