- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $432.90 / $2,016.16 / $7,212.00
| Facility | | $432.90 | $2,016.16 | $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
- $464.13 / $632.91 / $949.37
| Facility | | $464.13 | $632.91 | $949.37 |
- 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 |