- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $258.10 / $1,151.77 / $7,212.00
| Facility | | $258.10 | $1,151.77 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,153.00 / $7,572.00 / $16,778.00
| Facility | | $1,153.00 | $7,572.00 | $16,778.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $235.74 / $306.45 / $1,403.84
| Facility | | $235.74 | $306.45 | $1,403.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.00 / $761.00 / $2,258.41
| Facility | | $443.00 | $761.00 | $2,258.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,029.00 / $7,830.00 / $11,284.00
| Facility | | $2,029.00 | $7,830.00 | $11,284.00 |