- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.44 / $3,396.00 / $14,063.00
| Facility | | $319.44 | $3,396.00 | $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
- $320.17 / $439.45 / $659.18
| Facility | | $320.17 | $439.45 | $659.18 |
- 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
- $2,400.00 / $3,870.00 / $6,436.00
| Facility | | $2,400.00 | $3,870.00 | $6,436.00 |