- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.85 / $3,500.00 / $14,063.00
| Facility | | $832.85 | $3,500.00 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,065.00 / $9,219.00 / $37,919.46
| Facility | | $3,065.00 | $9,219.00 | $37,919.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $828.98 / $1,137.82 / $1,706.73
| Facility | | $828.98 | $1,137.82 | $1,706.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,928.53 / $11,928.53 / $14,140.10
| Facility | | $11,928.53 | $11,928.53 | $14,140.10 |
- 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 |