- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $465.09 / $1,941.00 / $7,212.00
| Facility | | $465.09 | $1,941.00 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,943.00 / $5,126.00 / $8,240.00
| Facility | | $1,943.00 | $5,126.00 | $8,240.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $462.94 / $635.40 / $953.10
| Facility | | $462.94 | $635.40 | $953.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,239.56 / $1,239.56 / $1,469.38
| Facility | | $1,239.56 | $1,239.56 | $1,469.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,364.00 / $6,032.00 / $10,413.00
| Facility | | $3,364.00 | $6,032.00 | $10,413.00 |