- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $568.03 / $3,000.00 / $11,093.00
| Facility | | $568.03 | $3,000.00 | $11,093.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,140.00 / $5,948.00 / $9,462.00
| Facility | | $2,140.00 | $5,948.00 | $9,462.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $541.35 / $703.76 / $812.03
| Facility | | $541.35 | $703.76 | $812.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,123.45 / $1,123.45 / $1,331.74
| Facility | | $1,123.45 | $1,123.45 | $1,331.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,400.00 / $3,874.00 / $5,490.00
| Facility | | $2,400.00 | $3,874.00 | $5,490.00 |