- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.27 / $2,318.00 / $14,063.00
| Facility | | $363.27 | $2,318.00 | $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
- $368.05 / $505.16 / $757.74
| Facility | | $368.05 | $505.16 | $757.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,239.56 / $1,239.56 / $1,469.38
| Facility | | $1,239.56 | $1,239.56 | $1,469.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,138.00 / $6,032.00 / $10,413.00
| Facility | | $3,138.00 | $6,032.00 | $10,413.00 |