- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $783.26 / $4,230.00 / $9,870.00
| Facility | | $783.26 | $4,230.00 | $9,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,768.35 / $7,239.95 / $12,392.04
| Facility | | $2,768.35 | $7,239.95 | $12,392.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,208.42 / $3,208.42 / $4,122.88
| Facility | | $3,208.42 | $3,208.42 | $4,122.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.52 / $861.59 / $1,416.11
| Facility | | $627.52 | $861.59 | $1,416.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $19,627.00 / $25,620.00
| Facility | | $3,028.00 | $19,627.00 | $25,620.00 |