- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.59 / $1,749.12 / $14,063.00
| Facility | | $680.59 | $1,749.12 | $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
- $652.89 / $848.76 / $979.34
| Facility | | $652.89 | $848.76 | $979.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,745.03 / $2,745.03 / $3,253.96
| Facility | | $2,745.03 | $2,745.03 | $3,253.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,462.00 / $3,782.00 / $5,402.00
| Facility | | $2,462.00 | $3,782.00 | $5,402.00 |