- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.82 / $4,996.45 / $15,575.00
| Facility | | $319.82 | $4,996.45 | $15,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,278.00 / $7,581.00 / $14,620.00
| Facility | | $3,278.00 | $7,581.00 | $14,620.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.92 / $351.66 / $438.37
| Facility | | $275.92 | $351.66 | $438.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,243.79 / $2,243.79 / $2,243.79
| Facility | | $2,243.79 | $2,243.79 | $2,243.79 |
- 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 |