- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $821.50 / $4,884.27 / $8,031.00
| Facility | | $821.50 | $4,884.27 | $8,031.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,410.00 / $7,483.00 / $15,501.00
| Facility | | $5,410.00 | $7,483.00 | $15,501.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $737.00 / $2,296.86 / $2,296.86
| Facility | | $737.00 | $2,296.86 | $2,296.86 |
- 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
- $1,380.00 / $3,075.00 / $6,664.00
| Facility | | $1,380.00 | $3,075.00 | $6,664.00 |