- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $442.13 / $2,318.00 / $14,063.00
| Facility | | $442.13 | $2,318.00 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,807.00 / $6,653.00 / $11,752.00
| Facility | | $2,807.00 | $6,653.00 | $11,752.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $437.29 / $617.36 / $926.04
| Facility | | $437.29 | $617.36 | $926.04 |
- 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 |