- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $872.00 / $3,186.00 / $10,893.00
| Facility | | $872.00 | $3,186.00 | $10,893.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,080.27 / $8,160.54 / $16,049.06
| Facility | | $4,080.27 | $8,160.54 | $16,049.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $837.88 / $837.88 / $837.88
| Facility | | $837.88 | $837.88 | $837.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,472.84 / $5,897.00 / $11,644.00
| Facility | | $5,472.84 | $5,897.00 | $11,644.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $980.52 / $1,305.19 / $2,166.79
| Facility | | $980.52 | $1,305.19 | $2,166.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $972.16 / $1,323.37 / $2,512.03
| Facility | | $972.16 | $1,323.37 | $2,512.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,634.00 / $4,345.00 / $10,600.00
| Facility | | $1,634.00 | $4,345.00 | $10,600.00 |