- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $642.07 / $2,318.00 / $14,063.00
| Facility | | $642.07 | $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
- $622.08 / $832.82 / $1,259.72
| Facility | | $622.08 | $832.82 | $1,259.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $560.00 / $765.29 / $1,375.01
| Facility | | $560.00 | $765.29 | $1,375.01 |
- 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 |