- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $656.74 / $2,318.00 / $11,093.00
| Facility | | $656.74 | $2,318.00 | $11,093.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,318.00 / $6,474.00 / $13,758.00
| Facility | | $2,318.00 | $6,474.00 | $13,758.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $654.27 / $898.02 / $1,347.03
| Facility | | $654.27 | $898.02 | $1,347.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,116.34 / $2,116.34 / $2,508.71
| Facility | | $2,116.34 | $2,116.34 | $2,508.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,719.19 / $7,672.00 / $11,284.00
| Facility | | $2,719.19 | $7,672.00 | $11,284.00 |