- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $736.22 / $5,336.21 / $9,643.65
| Facility | | $736.22 | $5,336.21 | $9,643.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $2,710.28
| Facility | | $606.10 | $606.10 | $2,710.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $525.23 / $703.22 / $1,001.00
| Facility | | $525.23 | $703.22 | $1,001.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,248.00 / $9,541.00 / $14,589.00
| Facility | | $2,248.00 | $9,541.00 | $14,589.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,539.30 / $8,957.00 / $33,500.00
| Facility | | $2,539.30 | $8,957.00 | $33,500.00 |