- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $808.84 / $3,394.00 / $10,439.00
| Facility | | $808.84 | $3,394.00 | $10,439.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,461.10 / $4,532.06 / $14,036.98
| Facility | | $1,461.10 | $4,532.06 | $14,036.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $442.00 / $442.00 / $442.00
| Facility | | $442.00 | $442.00 | $442.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $643.17 / $1,051.56 / $6,969.00
| Facility | | $643.17 | $1,051.56 | $6,969.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,820.00 / $5,693.64 / $11,702.05
| Facility | | $2,820.00 | $5,693.64 | $11,702.05 |