- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.27 / $4,305.00 / $8,031.00
| Facility | | $875.27 | $4,305.00 | $8,031.00 |
- 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 / $1,940.64 / $1,940.64
| Facility | | $550.00 | $1,940.64 | $1,940.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,458.67 / $2,935.00 / $2,995.00
| Facility | | $2,458.67 | $2,935.00 | $2,995.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,157.00 / $4,210.00 / $7,760.00
| Facility | | $1,157.00 | $4,210.00 | $7,760.00 |