- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,447.00 / $5,260.00
| Facility | | $860.00 | $2,447.00 | $5,260.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,458.17 / $8,301.42 / $14,106.04
| Facility | | $5,458.17 | $8,301.42 | $14,106.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.00 / $6,617.35 / $6,617.35
| Facility | | $791.00 | $6,617.35 | $6,617.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,802.00 / $1,802.00 / $1,802.00
| Facility | | $1,802.00 | $1,802.00 | $1,802.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $6,034.00 / $13,506.00
| Facility | | $1,200.00 | $6,034.00 | $13,506.00 |