- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $593.00 / $1,520.00 / $3,728.00
| Facility | | $593.00 | $1,520.00 | $3,728.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,781.29 / $5,184.81 / $10,316.54
| Facility | | $2,781.29 | $5,184.81 | $10,316.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.22 / $6,883.14 / $6,883.14
| Facility | | $371.22 | $6,883.14 | $6,883.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $486.62 / $650.00 / $3,746.89
| Facility | | $486.62 | $650.00 | $3,746.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.00 / $2,415.00 / $6,661.00
| Facility | | $746.00 | $2,415.00 | $6,661.00 |