- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $901.24 / $2,318.00 / $11,093.00
| Facility | | $901.24 | $2,318.00 | $11,093.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,473.00 / $6,716.00 / $13,758.00
| Facility | | $3,473.00 | $6,716.00 | $13,758.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $897.03 / $1,231.22 / $1,846.83
| Facility | | $897.03 | $1,231.22 | $1,846.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,705.12 / $4,705.12 / $5,577.46
| Facility | | $4,705.12 | $4,705.12 | $5,577.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,472.00 / $10,113.00 / $15,750.00
| Facility | | $4,472.00 | $10,113.00 | $15,750.00 |