- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $809.68 / $2,080.88 / $14,063.00
| Facility | | $809.68 | $2,080.88 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,310.00 / $6,340.00 / $15,727.00
| Facility | | $2,310.00 | $6,340.00 | $15,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $784.65 / $1,020.05 / $1,176.98
| Facility | | $784.65 | $1,020.05 | $1,176.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,909.74 / $3,909.74 / $4,634.62
| Facility | | $3,909.74 | $3,909.74 | $4,634.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,472.00 / $10,113.00 / $15,750.00
| Facility | | $4,472.00 | $10,113.00 | $15,750.00 |