- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $382.76 / $3,003.95 / $5,634.00
| Facility | | $382.76 | $3,003.95 | $5,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,682.00 / $3,840.00 / $7,747.00
| Facility | | $1,682.00 | $3,840.00 | $7,747.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $383.11 / $488.28 / $563.40
| Facility | | $383.11 | $488.28 | $563.40 |
- 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
- $3,932.00 / $8,025.00 / $11,038.00
| Facility | | $3,932.00 | $8,025.00 | $11,038.00 |