- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $320.70 / $1,243.00 / $10,647.00
| Facility | | $320.70 | $1,243.00 | $10,647.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,584.00 / $10,099.00 / $11,870.00
| Facility | | $8,584.00 | $10,099.00 | $11,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $310.39 / $426.03 / $491.45
| Facility | | $310.39 | $426.03 | $491.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $374.38 / $374.38 / $374.38
| Facility | | $374.38 | $374.38 | $374.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,000.00 / $17,439.00 / $33,762.00
| Facility | | $3,000.00 | $17,439.00 | $33,762.00 |