- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $267.89 / $4,440.79 / $10,264.40
| Facility | | $267.89 | $4,440.79 | $10,264.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,528.94 / $7,533.12 / $13,582.15
| Facility | | $2,528.94 | $7,533.12 | $13,582.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $391.17 / $4,050.97
| Facility | | $375.00 | $391.17 | $4,050.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $148.68 / $276.81 / $680.91
| Facility | | $148.68 | $276.81 | $680.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,545.36 / $12,189.00 / $19,665.00
| Facility | | $2,545.36 | $12,189.00 | $19,665.00 |