- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $881.57 / $2,265.63 / $7,212.00
| Facility | | $881.57 | $2,265.63 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,411.35 / $7,572.00 / $18,942.00
| Facility | | $1,411.35 | $7,572.00 | $18,942.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $854.81 / $1,111.25 / $1,282.22
| Facility | | $854.81 | $1,111.25 | $1,282.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,610.75 / $1,610.75 / $1,909.39
| Facility | | $1,610.75 | $1,610.75 | $1,909.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,400.00 / $3,874.00 / $5,490.00
| Facility | | $2,400.00 | $3,874.00 | $5,490.00 |