- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $733.18 / $3,000.00 / $11,093.00
| Facility | | $733.18 | $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
- $738.07 / $1,013.04 / $1,519.56
| Facility | | $738.07 | $1,013.04 | $1,519.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,794.57 / $6,794.57 / $8,054.29
| Facility | | $6,794.57 | $6,794.57 | $8,054.29 |
- 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 |