- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $648.89 / $1,773.00 / $5,634.00
| Facility | | $648.89 | $1,773.00 | $5,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,682.00 / $3,950.00 / $13,758.00
| Facility | | $1,682.00 | $3,950.00 | $13,758.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.57 / $865.49 / $1,298.24
| Facility | | $630.57 | $865.49 | $1,298.24 |
- 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
- $3,364.00 / $6,032.00 / $10,413.00
| Facility | | $3,364.00 | $6,032.00 | $10,413.00 |