- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $876.65 / $4,884.27 / $8,031.00
| Facility | | $876.65 | $4,884.27 | $8,031.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,410.00 / $6,763.00 / $11,830.00
| Facility | | $5,410.00 | $6,763.00 | $11,830.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $737.00 / $3,293.13 / $3,293.13
| Facility | | $737.00 | $3,293.13 | $3,293.13 |
- 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 |