- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $669.25 / $1,850.00 / $3,945.00
| Facility | | $669.25 | $1,850.00 | $3,945.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,216.55 / $6,298.38 / $10,652.65
| Facility | | $3,216.55 | $6,298.38 | $10,652.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $413.03 / $5,354.94 / $5,354.94
| Facility | | $413.03 | $5,354.94 | $5,354.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $488.00 / $541.36 / $4,905.85
| Facility | | $488.00 | $541.36 | $4,905.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $689.00 / $2,415.00 / $6,661.00
| Facility | | $689.00 | $2,415.00 | $6,661.00 |