- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $313.32 / $4,884.27 / $8,031.00
| Facility | | $313.32 | $4,884.27 | $8,031.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,410.00 / $6,763.00 / $10,956.00
| Facility | | $5,410.00 | $6,763.00 | $10,956.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $737.00 / $1,940.64 / $1,940.64
| Facility | | $737.00 | $1,940.64 | $1,940.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,458.67 / $2,935.00 / $2,995.00
| Facility | | $2,458.67 | $2,935.00 | $2,995.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,614.00 / $5,307.00 / $8,879.00
| Facility | | $2,614.00 | $5,307.00 | $8,879.00 |