- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $798.44 / $3,000.00 / $11,093.00
| Facility | | $798.44 | $3,000.00 | $11,093.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,473.00 / $7,890.00 / $32,252.00
| Facility | | $3,473.00 | $7,890.00 | $32,252.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $792.26 / $1,087.42 / $1,631.13
| Facility | | $792.26 | $1,087.42 | $1,631.13 |
- 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
- $3,932.00 / $8,348.00 / $12,569.00
| Facility | | $3,932.00 | $8,348.00 | $12,569.00 |