- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.46 / $2,318.00 / $14,063.00
| Facility | | $443.46 | $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
- $432.46 / $578.96 / $875.73
| Facility | | $432.46 | $578.96 | $875.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $529.78 / $674.90 / $1,627.38
| Facility | | $529.78 | $674.90 | $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 |