- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $898.06 / $3,362.00 / $9,304.00
| Facility | | $898.06 | $3,362.00 | $9,304.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,214.00 / $10,011.00
| Facility | | $2,088.00 | $4,214.00 | $10,011.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $356.30 / $356.30 / $356.30
| Facility | | $356.30 | $356.30 | $356.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $200.59 / $812.74 / $2,122.21
| Facility | | $200.59 | $812.74 | $2,122.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,708.00 / $3,700.00 / $6,944.00
| Facility | | $1,708.00 | $3,700.00 | $6,944.00 |