- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $242.94 / $4,846.00 / $14,483.00
| Facility | | $242.94 | $4,846.00 | $14,483.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,614.00 / $10,300.00 / $21,000.00
| Facility | | $1,614.00 | $10,300.00 | $21,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $192.57 / $245.43 / $283.19
| Facility | | $192.57 | $245.43 | $283.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,618.46 / $2,618.46 / $2,618.46
| Facility | | $2,618.46 | $2,618.46 | $2,618.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,932.00 / $8,025.00 / $11,038.00
| Facility | | $3,932.00 | $8,025.00 | $11,038.00 |