- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $905.88 / $1,489.94 / $7,212.00
| Facility | | $905.88 | $1,489.94 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,796.00 / $6,340.00 / $15,727.00
| Facility | | $2,796.00 | $6,340.00 | $15,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $899.25 / $1,146.10 / $1,322.43
| Facility | | $899.25 | $1,146.10 | $1,322.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,379.37 / $3,379.37 / $3,379.37
| Facility | | $3,379.37 | $3,379.37 | $3,379.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,932.00 / $8,348.00 / $11,284.00
| Facility | | $3,932.00 | $8,348.00 | $11,284.00 |