- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $962.47 / $962.47 / $962.47
| Facility | | $962.47 | $962.47 | $962.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,548.13 / $8,612.58 / $16,659.50
| Facility | | $6,548.13 | $8,612.58 | $16,659.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $962.47 / $1,684.32 / $8,220.00
| Facility | | $962.47 | $1,684.32 | $8,220.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,244.18 / $2,420.84 / $3,157.25
| Facility | | $1,244.18 | $2,420.84 | $3,157.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $8,220.00 / $9,696.00
| Facility | | $6,777.00 | $8,220.00 | $9,696.00 |