- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $547.36 / $3,500.00 / $14,063.00
| Facility | | $547.36 | $3,500.00 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.00 / $6,818.00 / $11,598.00
| Facility | | $2,754.00 | $6,818.00 | $11,598.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $507.93 / $660.31 / $761.90
| Facility | | $507.93 | $660.31 | $761.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $633.12 / $761.00 / $1,873.52
| Facility | | $633.12 | $761.00 | $1,873.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,298.30 / $6,741.00 / $11,284.00
| Facility | | $2,298.30 | $6,741.00 | $11,284.00 |