- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.00 / $2,758.00 / $5,432.00
| Facility | | $941.00 | $2,758.00 | $5,432.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,765.26 / $7,393.81 / $10,896.55
| Facility | | $3,765.26 | $7,393.81 | $10,896.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,505.01 / $3,505.01 / $3,505.01
| Facility | | $3,505.01 | $3,505.01 | $3,505.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,336.00 / $1,336.00 / $1,336.00
| Facility | | $1,336.00 | $1,336.00 | $1,336.00 |
- 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 |