- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $460.85 / $3,500.00 / $11,093.00
| Facility | | $460.85 | $3,500.00 | $11,093.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,309.00 / $6,474.00 / $13,758.00
| Facility | | $3,309.00 | $6,474.00 | $13,758.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $481.35 / $634.26 / $951.39
| Facility | | $481.35 | $634.26 | $951.39 |
- 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
- $3,932.00 / $8,348.00 / $12,569.00
| Facility | | $3,932.00 | $8,348.00 | $12,569.00 |