- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $381.06 / $2,070.89 / $5,634.00
| Facility | | $381.06 | $2,070.89 | $5,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,614.00 / $9,200.00 / $18,942.00
| Facility | | $1,614.00 | $9,200.00 | $18,942.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $314.08 / $413.84 / $641.34
| Facility | | $314.08 | $413.84 | $641.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,129.11 / $2,129.11 / $2,129.11
| Facility | | $2,129.11 | $2,129.11 | $2,129.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,932.00 / $8,348.00 / $11,038.00
| Facility | | $3,932.00 | $8,348.00 | $11,038.00 |