- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $592.13 / $2,318.00 / $14,063.00
| Facility | | $592.13 | $2,318.00 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,807.00 / $6,653.00 / $11,752.00
| Facility | | $2,807.00 | $6,653.00 | $11,752.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $572.05 / $765.84 / $1,158.42
| Facility | | $572.05 | $765.84 | $1,158.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $560.00 / $704.26 / $1,627.38
| Facility | | $560.00 | $704.26 | $1,627.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,399.00 / $5,995.00 / $10,413.00
| Facility | | $1,399.00 | $5,995.00 | $10,413.00 |