- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $149.08 / $4,305.00 / $8,031.00
| Facility | | $149.08 | $4,305.00 | $8,031.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,410.00 / $6,763.00 / $11,797.00
| Facility | | $5,410.00 | $6,763.00 | $11,797.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $353.26 / $353.26 / $550.00
| Facility | | $353.26 | $353.26 | $550.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,340.80 / $1,643.00 / $1,677.00
| Facility | | $1,340.80 | $1,643.00 | $1,677.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.00 / $3,134.00 / $6,664.00
| Facility | | $1,380.00 | $3,134.00 | $6,664.00 |