- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $979.82 / $3,000.00 / $11,093.00
| Facility | | $979.82 | $3,000.00 | $11,093.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,065.00 / $7,890.00 / $37,919.46
| Facility | | $3,065.00 | $7,890.00 | $37,919.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,015.41 / $1,337.95 / $2,006.93
| Facility | | $1,015.41 | $1,337.95 | $2,006.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,074.26 / $12,074.26 / $14,312.85
| Facility | | $12,074.26 | $12,074.26 | $14,312.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,058.00 / $12,330.00 / $17,416.00
| Facility | | $5,058.00 | $12,330.00 | $17,416.00 |