- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $775.88 / $4,470.00 / $10,897.83
| Facility | | $775.88 | $4,470.00 | $10,897.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $947.15 / $2,251.80 / $4,216.75
| Facility | | $947.15 | $2,251.80 | $4,216.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $505.00 / $505.00
| Facility | | $505.00 | $505.00 | $505.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $581.87 / $856.23 / $6,026.00
| Facility | | $581.87 | $856.23 | $6,026.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,521.00 / $2,281.10 / $5,562.00
| Facility | | $1,521.00 | $2,281.10 | $5,562.00 |