- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.15 / $1,123.00 / $11,093.00
| Facility | | $380.15 | $1,123.00 | $11,093.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,411.35 / $7,558.00 / $18,942.00
| Facility | | $1,411.35 | $7,558.00 | $18,942.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $378.33 / $519.27 / $778.91
| Facility | | $378.33 | $519.27 | $778.91 |
- 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
- $3,364.00 / $6,032.00 / $10,413.00
| Facility | | $3,364.00 | $6,032.00 | $10,413.00 |