- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $277.33 / $1,386.00 / $7,212.00
| Facility | | $277.33 | $1,386.00 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,796.00 / $6,422.00 / $25,221.00
| Facility | | $2,796.00 | $6,422.00 | $25,221.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $259.10 / $330.23 / $381.03
| Facility | | $259.10 | $330.23 | $381.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,982.66 / $2,982.66 / $2,982.66
| Facility | | $2,982.66 | $2,982.66 | $2,982.66 |
- 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 |