- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $839.36 / $2,318.00 / $7,212.00
| Facility | | $839.36 | $2,318.00 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,266.00 / $5,570.00 / $13,810.27
| Facility | | $2,266.00 | $5,570.00 | $13,810.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $824.44 / $1,200.85 / $1,293.24
| Facility | | $824.44 | $1,200.85 | $1,293.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,623.15 / $2,623.15 / $2,623.15
| Facility | | $2,623.15 | $2,623.15 | $2,623.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,932.00 / $8,025.00 / $11,038.00
| Facility | | $3,932.00 | $8,025.00 | $11,038.00 |