- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $301.01 / $1,386.00 / $7,212.00
| Facility | | $301.01 | $1,386.00 | $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
- $303.14 / $386.37 / $445.82
| Facility | | $303.14 | $386.37 | $445.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,218.40 / $2,218.40 / $2,218.40
| Facility | | $2,218.40 | $2,218.40 | $2,218.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,148.00 / $6,094.00 / $12,090.00
| Facility | | $2,148.00 | $6,094.00 | $12,090.00 |