- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.00 / $2,397.00 / $4,991.00
| Facility | | $756.00 | $2,397.00 | $4,991.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,685.45 / $7,304.84 / $10,766.15
| Facility | | $3,685.45 | $7,304.84 | $10,766.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,839.14 / $4,839.14 / $4,839.14
| Facility | | $4,839.14 | $4,839.14 | $4,839.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $848.00 / $848.00 / $848.00
| Facility | | $848.00 | $848.00 | $848.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.00 / $2,415.00 / $6,585.00
| Facility | | $746.00 | $2,415.00 | $6,585.00 |