- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $613.98 / $2,318.00 / $14,063.00
| Facility | | $613.98 | $2,318.00 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,807.00 / $7,833.00 / $14,645.00
| Facility | | $2,807.00 | $7,833.00 | $14,645.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $642.42 / $881.76 / $1,322.64
| Facility | | $642.42 | $881.76 | $1,322.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,705.12 / $4,705.12 / $5,577.46
| Facility | | $4,705.12 | $4,705.12 | $5,577.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,126.00 / $7,672.00 / $11,284.00
| Facility | | $4,126.00 | $7,672.00 | $11,284.00 |