- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,447.00 / $5,687.00
| Facility | | $860.00 | $2,447.00 | $5,687.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,765.26 / $6,828.32 / $9,419.06
| Facility | | $3,765.26 | $6,828.32 | $9,419.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,284.07 / $3,284.07 / $3,284.07
| Facility | | $3,284.07 | $3,284.07 | $3,284.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $965.00 / $965.00 / $965.00
| Facility | | $965.00 | $965.00 | $965.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,141.00 / $4,717.00 / $10,810.00
| Facility | | $1,141.00 | $4,717.00 | $10,810.00 |