- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,372.00 / $6,372.00 / $6,617.00
| Facility | | $6,372.00 | $6,372.00 | $6,617.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,169.07 / $5,644.81 / $5,774.14
| Facility | | $2,169.07 | $5,644.81 | $5,774.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.08 / $371.96 / $1,626.14
| Facility | | $30.08 | $371.96 | $1,626.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,006.00 / $6,186.00 / $9,812.00
| Facility | | $6,006.00 | $6,186.00 | $9,812.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,714.00 / $12,166.00 / $12,730.00
| Facility | | $11,714.00 | $12,166.00 | $12,730.00 |