- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $626.71 / $3,000.00 / $11,093.00
| Facility | | $626.71 | $3,000.00 | $11,093.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,473.00 / $7,890.00 / $30,900.00
| Facility | | $3,473.00 | $7,890.00 | $30,900.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $626.63 / $860.08 / $1,290.11
| Facility | | $626.63 | $860.08 | $1,290.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,987.53 / $5,987.53 / $7,097.63
| Facility | | $5,987.53 | $5,987.53 | $7,097.63 |
- 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 |