- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $583.10 / $2,318.00 / $11,093.00
| Facility | | $583.10 | $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
- $569.50 / $829.52 / $893.33
| Facility | | $569.50 | $829.52 | $893.33 |
- 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 |