- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $936.00 / $2,897.00 / $6,483.00
| Facility | | $936.00 | $2,897.00 | $6,483.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $525.60 / $2,063.64 / $3,438.74
| Facility | | $525.60 | $2,063.64 | $3,438.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,633.82 / $4,633.82 / $4,633.82
| Facility | | $4,633.82 | $4,633.82 | $4,633.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.28 / $957.19 / $6,014.00
| Facility | | $70.28 | $957.19 | $6,014.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,613.00 / $6,455.00 / $9,010.00
| Facility | | $4,613.00 | $6,455.00 | $9,010.00 |