- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $589.46 / $3,500.00 / $14,063.00
| Facility | | $589.46 | $3,500.00 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.00 / $6,653.00 / $11,752.00
| Facility | | $2,754.00 | $6,653.00 | $11,752.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.77 / $731.60 / $844.16
| Facility | | $562.77 | $731.60 | $844.16 |
- 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 |