- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,447.00 / $5,260.00
| Facility | | $860.00 | $2,447.00 | $5,260.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,898.80 / $10,203.95 / $14,106.04
| Facility | | $5,898.80 | $10,203.95 | $14,106.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $565.48 / $565.48 / $565.48
| Facility | | $565.48 | $565.48 | $565.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,802.00 / $1,802.00 / $1,802.00
| Facility | | $1,802.00 | $1,802.00 | $1,802.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $5,780.00 / $13,506.00
| Facility | | $1,200.00 | $5,780.00 | $13,506.00 |