- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.40 / $2,138.00 / $7,293.00
| Facility | | $831.40 | $2,138.00 | $7,293.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,714.07 / $4,714.07 / $5,656.88
| Facility | | $4,714.07 | $4,714.07 | $5,656.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,062.48 / $1,062.48 / $1,062.48
| Facility | | $1,062.48 | $1,062.48 | $1,062.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,539.88 / $4,539.88 / $4,539.88
| Facility | | $4,539.88 | $4,539.88 | $4,539.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,565.00 / $2,828.00 / $6,957.00
| Facility | | $1,565.00 | $2,828.00 | $6,957.00 |