- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $565.62 / $3,000.00 / $11,093.00
| Facility | | $565.62 | $3,000.00 | $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
- $565.64 / $776.37 / $1,164.56
| Facility | | $565.64 | $776.37 | $1,164.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,610.75 / $1,610.75 / $1,909.39
| Facility | | $1,610.75 | $1,610.75 | $1,909.39 |
- 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 |