- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $272.27 / $2,318.00 / $7,212.00
| Facility | | $272.27 | $2,318.00 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,310.00 / $6,340.00 / $15,727.00
| Facility | | $2,310.00 | $6,340.00 | $15,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $267.75 / $348.08 / $383.24
| Facility | | $267.75 | $348.08 | $383.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,140.62 / $4,140.62 / $4,908.29
| Facility | | $4,140.62 | $4,140.62 | $4,908.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,058.00 / $12,330.00 / $17,416.00
| Facility | | $5,058.00 | $12,330.00 | $17,416.00 |