- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.50 / $2,014.78 / $4,878.00
| Facility | | $756.50 | $2,014.78 | $4,878.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,685.25 / $9,738.61 / $14,454.86
| Facility | | $5,685.25 | $9,738.61 | $14,454.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.65 / $2,012.96 / $2,012.96
| Facility | | $822.65 | $2,012.96 | $2,012.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,802.00 / $1,802.00 / $1,802.00
| Facility | | $1,802.00 | $1,802.00 | $1,802.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,305.00 / $7,450.00 / $15,847.00
| Facility | | $1,305.00 | $7,450.00 | $15,847.00 |