- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $581.27 / $1,520.00 / $3,779.00
| Facility | | $581.27 | $1,520.00 | $3,779.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,710.20 / $8,032.13 / $12,665.76
| Facility | | $4,710.20 | $8,032.13 | $12,665.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $368.58 / $1,372.14 / $1,372.14
| Facility | | $368.58 | $1,372.14 | $1,372.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $725.00 / $725.00 / $725.00
| Facility | | $725.00 | $725.00 | $725.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,141.00 / $4,717.00 / $11,696.00
| Facility | | $1,141.00 | $4,717.00 | $11,696.00 |