- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $637.67 / $6,480.00 / $9,650.00
| Facility | | $637.67 | $6,480.00 | $9,650.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,434.16 / $2,434.16 / $2,434.16
| Facility | | $2,434.16 | $2,434.16 | $2,434.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,052.00 / $3,052.00 / $3,571.00
| Facility | | $3,052.00 | $3,052.00 | $3,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $379.76 / $486.53 / $806.67
| Facility | | $379.76 | $486.53 | $806.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,360.00 / $6,427.00 / $12,199.00
| Facility | | $1,360.00 | $6,427.00 | $12,199.00 |