- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $498.37 / $3,000.00 / $11,093.00
| Facility | | $498.37 | $3,000.00 | $11,093.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,529.00 / $7,881.00 / $30,900.00
| Facility | | $3,529.00 | $7,881.00 | $30,900.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $498.45 / $684.15 / $1,026.23
| Facility | | $498.45 | $684.15 | $1,026.23 |
- 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
- $5,431.00 / $12,330.00 / $17,416.00
| Facility | | $5,431.00 | $12,330.00 | $17,416.00 |