- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.17 / $3,922.46 / $7,954.00
| Facility | | $707.17 | $3,922.46 | $7,954.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,309.00 / $6,474.00 / $13,810.27
| Facility | | $3,309.00 | $6,474.00 | $13,810.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $670.65 / $854.75 / $986.25
| Facility | | $670.65 | $854.75 | $986.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,218.40 / $2,218.40 / $2,218.40
| Facility | | $2,218.40 | $2,218.40 | $2,218.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,699.00 / $10,000.00 / $15,750.00
| Facility | | $4,699.00 | $10,000.00 | $15,750.00 |