- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,546.69 / $5,687.00
| Facility | | $860.00 | $2,546.69 | $5,687.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,898.80 / $10,230.67 / $14,577.45
| Facility | | $5,898.80 | $10,230.67 | $14,577.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,212.22 / $5,655.43 / $5,655.43
| Facility | | $1,212.22 | $5,655.43 | $5,655.43 |
- 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 |