- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $577.51 / $2,318.00 / $11,093.00
| Facility | | $577.51 | $2,318.00 | $11,093.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.00 / $5,948.00 / $9,462.00
| Facility | | $2,754.00 | $5,948.00 | $9,462.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.79 / $819.75 / $882.81
| Facility | | $562.79 | $819.75 | $882.81 |
- 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
- $3,364.00 / $6,094.00 / $10,413.00
| Facility | | $3,364.00 | $6,094.00 | $10,413.00 |