- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $675.28 / $4,459.46 / $7,212.00
| Facility | | $675.28 | $4,459.46 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,796.00 / $6,340.00 / $15,727.00
| Facility | | $2,796.00 | $6,340.00 | $15,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.95 / $816.89 / $942.57
| Facility | | $640.95 | $816.89 | $942.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,379.37 / $3,379.37 / $3,379.37
| Facility | | $3,379.37 | $3,379.37 | $3,379.37 |
- 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 |