- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $908.78 / $5,194.00 / $10,492.00
| Facility | | $908.78 | $5,194.00 | $10,492.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,410.00 / $6,763.00 / $10,432.00
| Facility | | $5,410.00 | $6,763.00 | $10,432.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $550.00 / $550.00 / $550.00
| Facility | | $550.00 | $550.00 | $550.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,340.80 / $1,643.00 / $1,677.00
| Facility | | $1,340.80 | $1,643.00 | $1,677.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.00 / $3,134.00 / $6,664.00
| Facility | | $1,380.00 | $3,134.00 | $6,664.00 |