- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,074.00 / $4,450.00 / $8,031.00
| Facility | | $2,074.00 | $4,450.00 | $8,031.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,410.00 / $6,763.00 / $11,830.00
| Facility | | $5,410.00 | $6,763.00 | $11,830.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $550.00 / $3,293.13 / $3,293.13
| Facility | | $550.00 | $3,293.13 | $3,293.13 |
- 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
- $4,565.00 / $6,647.00 / $9,973.00
| Facility | | $4,565.00 | $6,647.00 | $9,973.00 |