- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $310.89 / $1,123.00 / $11,093.00
| Facility | | $310.89 | $1,123.00 | $11,093.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,536.00 / $9,989.00 / $15,154.00
| Facility | | $3,536.00 | $9,989.00 | $15,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.97 / $393.78 / $454.37
| Facility | | $308.97 | $393.78 | $454.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,218.40 / $2,218.40 / $2,218.40
| Facility | | $2,218.40 | $2,218.40 | $2,218.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,364.00 / $6,094.00 / $10,413.00
| Facility | | $3,364.00 | $6,094.00 | $10,413.00 |