- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.26 / $4,406.63 / $8,031.00
| Facility | | $407.26 | $4,406.63 | $8,031.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,786.00 / $8,873.00 / $12,904.00
| Facility | | $5,786.00 | $8,873.00 | $12,904.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $550.00 / $6,788.51 / $6,788.51
| Facility | | $550.00 | $6,788.51 | $6,788.51 |
- 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
- $5,325.00 / $7,843.00 / $11,438.00
| Facility | | $5,325.00 | $7,843.00 | $11,438.00 |