- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $527.08 / $2,318.00 / $11,093.00
| Facility | | $527.08 | $2,318.00 | $11,093.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,309.00 / $6,474.00 / $13,810.27
| Facility | | $3,309.00 | $6,474.00 | $13,810.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $506.84 / $738.26 / $795.05
| Facility | | $506.84 | $738.26 | $795.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,610.75 / $1,610.75 / $1,610.75
| Facility | | $1,610.75 | $1,610.75 | $1,610.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,400.00 / $3,870.00 / $5,490.00
| Facility | | $2,400.00 | $3,870.00 | $5,490.00 |