- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $428.29 / $1,941.00 / $7,212.00
| Facility | | $428.29 | $1,941.00 | $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
- $430.97 / $549.28 / $633.78
| Facility | | $430.97 | $549.28 | $633.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,061.25 / $2,061.25 / $2,061.25
| Facility | | $2,061.25 | $2,061.25 | $2,061.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,364.00 / $6,094.00 / $10,413.00
| Facility | | $3,364.00 | $6,094.00 | $10,413.00 |