- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $569.54 / $2,318.00 / $11,093.00
| Facility | | $569.54 | $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
- $566.57 / $777.64 / $1,166.46
| Facility | | $566.57 | $777.64 | $1,166.46 |
- 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
- $3,253.00 / $6,032.00 / $10,413.00
| Facility | | $3,253.00 | $6,032.00 | $10,413.00 |