- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,747.00 / $8,229.00
| Facility | | $860.00 | $2,747.00 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,241.00 / $9,565.00 / $11,253.00
| Facility | | $8,241.00 | $9,565.00 | $11,253.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,668.58 / $3,868.48 / $4,462.57
| Facility | | $2,668.58 | $3,868.48 | $4,462.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,391.14 / $3,391.14 / $3,470.52
| Facility | | $3,391.14 | $3,391.14 | $3,470.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $973.00 / $4,639.00 / $12,296.00
| Facility | | $973.00 | $4,639.00 | $12,296.00 |