- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $917.76 / $3,000.00 / $11,093.00
| Facility | | $917.76 | $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
- $945.02 / $1,245.20 / $1,867.80
| Facility | | $945.02 | $1,245.20 | $1,867.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,060.61 / $6,060.61 / $7,184.26
| Facility | | $6,060.61 | $6,060.61 | $7,184.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,051.00 / $11,452.00 / $17,416.00
| Facility | | $5,051.00 | $11,452.00 | $17,416.00 |