- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $782.47 / $4,884.27 / $8,031.00
| Facility | | $782.47 | $4,884.27 | $8,031.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,070.00 / $7,714.00 / $12,562.00
| Facility | | $5,070.00 | $7,714.00 | $12,562.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $737.00 / $4,326.79 / $4,326.79
| Facility | | $737.00 | $4,326.79 | $4,326.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,296.00 / $4,588.00 / $4,682.00
| Facility | | $3,296.00 | $4,588.00 | $4,682.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,565.00 / $6,647.00 / $9,973.00
| Facility | | $4,565.00 | $6,647.00 | $9,973.00 |