- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $866.81 / $2,758.00 / $5,608.00
| Facility | | $866.81 | $2,758.00 | $5,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,685.25 / $10,061.77 / $14,037.93
| Facility | | $5,685.25 | $10,061.77 | $14,037.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $572.57 / $4,287.00 / $4,287.00
| Facility | | $572.57 | $4,287.00 | $4,287.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,650.00 / $1,650.00 / $1,650.00
| Facility | | $1,650.00 | $1,650.00 | $1,650.00 |
- 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 |