- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $552.38 / $2,945.00 / $8,084.00
| Facility | | $552.38 | $2,945.00 | $8,084.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,232.00 / $4,286.00 / $9,663.00
| Facility | | $2,232.00 | $4,286.00 | $9,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,524.00 / $9,308.00 / $10,577.00
| Facility | | $4,524.00 | $9,308.00 | $10,577.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.80 / $560.33 / $3,532.00
| Facility | | $330.80 | $560.33 | $3,532.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,694.00 / $3,018.00 / $5,813.00
| Facility | | $1,694.00 | $3,018.00 | $5,813.00 |