- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.74 / $3,500.00 / $16,042.00
| Facility | | $425.74 | $3,500.00 | $16,042.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,390.00 / $10,182.00 / $16,615.00
| Facility | | $3,390.00 | $10,182.00 | $16,615.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $423.78 / $581.66 / $872.49
| Facility | | $423.78 | $581.66 | $872.49 |
- 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
- $3,364.00 / $6,032.00 / $10,413.00
| Facility | | $3,364.00 | $6,032.00 | $10,413.00 |