- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.54 / $4,846.00 / $12,027.48
| Facility | | $330.54 | $4,846.00 | $12,027.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,234.00 / $5,126.00 / $8,240.00
| Facility | | $2,234.00 | $5,126.00 | $8,240.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $274.10 / $349.35 / $437.56
| Facility | | $274.10 | $349.35 | $437.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,243.79 / $2,243.79 / $2,243.79
| Facility | | $2,243.79 | $2,243.79 | $2,243.79 |
- 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 |