- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $936.72 / $3,000.00 / $11,093.00
| Facility | | $936.72 | $3,000.00 | $11,093.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,445.00 / $6,474.00 / $13,002.00
| Facility | | $3,445.00 | $6,474.00 | $13,002.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $924.35 / $1,268.72 / $1,903.08
| Facility | | $924.35 | $1,268.72 | $1,903.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,963.58 / $5,963.58 / $7,069.24
| Facility | | $5,963.58 | $5,963.58 | $7,069.24 |
- 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 |