- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $837.40 / $1,688.00 / $9,872.48
| Facility | | $837.40 | $1,688.00 | $9,872.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,027.36 / $3,027.36 / $3,632.83
| Facility | | $3,027.36 | $3,027.36 | $3,632.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $820.24 / $893.72 / $2,553.53
| Facility | | $820.24 | $893.72 | $2,553.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.20 / $3,019.20 / $3,019.20
| Facility | | $3,019.20 | $3,019.20 | $3,019.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,240.00 / $2,268.00 / $5,626.00
| Facility | | $1,240.00 | $2,268.00 | $5,626.00 |