- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $504.07 / $4,846.00 / $9,479.90
| Facility | | $504.07 | $4,846.00 | $9,479.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,234.00 / $5,570.00 / $13,758.00
| Facility | | $2,234.00 | $5,570.00 | $13,758.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $504.48 / $692.43 / $1,038.65
| Facility | | $504.48 | $692.43 | $1,038.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,610.75 / $1,610.75 / $1,909.39
| Facility | | $1,610.75 | $1,610.75 | $1,909.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,400.00 / $3,874.00 / $5,490.00
| Facility | | $2,400.00 | $3,874.00 | $5,490.00 |