- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $598.15 / $4,230.00 / $9,870.00
| Facility | | $598.15 | $4,230.00 | $9,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,637.53 / $5,645.95 / $10,416.71
| Facility | | $2,637.53 | $5,645.95 | $10,416.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,831.77 / $2,831.77 / $3,638.88
| Facility | | $2,831.77 | $2,831.77 | $3,638.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.02 / $592.52 / $994.00
| Facility | | $470.02 | $592.52 | $994.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $12,456.00 / $19,591.00
| Facility | | $2,155.00 | $12,456.00 | $19,591.00 |