- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $403.28 / $5,297.00 / $8,031.00
| Facility | | $403.28 | $5,297.00 | $8,031.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,734.00 / $6,273.00 / $10,432.00
| Facility | | $4,734.00 | $6,273.00 | $10,432.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.00 / $1,020.00 / $1,020.00
| Facility | | $1,020.00 | $1,020.00 | $1,020.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $735.56 / $886.65 / $1,552.85
| Facility | | $735.56 | $886.65 | $1,552.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $357.00 / $3,075.00 / $6,664.00
| Facility | | $357.00 | $3,075.00 | $6,664.00 |