- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $837.00 / $2,674.97 / $11,068.36
| Facility | | $837.00 | $2,674.97 | $11,068.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,773.78 / $10,303.91 / $14,089.68
| Facility | | $5,773.78 | $10,303.91 | $14,089.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $678.10 / $6,970.24 / $6,970.24
| Facility | | $678.10 | $6,970.24 | $6,970.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $1,350.00 / $1,350.00
| Facility | | $1,350.00 | $1,350.00 | $1,350.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,141.00 / $4,717.00 / $11,696.00
| Facility | | $1,141.00 | $4,717.00 | $11,696.00 |