- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $945.00 / $3,682.00 / $12,040.00
| Facility | | $945.00 | $3,682.00 | $12,040.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,258.35 / $6,474.38 / $12,610.23
| Facility | | $3,258.35 | $6,474.38 | $12,610.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $819.32 / $819.32 / $819.32
| Facility | | $819.32 | $819.32 | $819.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,619.61 / $3,619.61 / $3,619.61
| Facility | | $3,619.61 | $3,619.61 | $3,619.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,500.00 / $26,542.00 / $26,542.00
| Facility | | $11,500.00 | $26,542.00 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $914.39 / $1,215.33 / $2,051.42
| Facility | | $914.39 | $1,215.33 | $2,051.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $914.39 / $1,227.17 / $2,345.19
| Facility | | $914.39 | $1,227.17 | $2,345.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,154.00 / $3,347.00 / $7,731.85
| Facility | | $1,154.00 | $3,347.00 | $7,731.85 |