- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $768.25 / $1,974.40 / $5,634.00
| Facility | | $768.25 | $1,974.40 | $5,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,411.35 / $10,300.00 / $21,000.00
| Facility | | $1,411.35 | $10,300.00 | $21,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $752.48 / $978.22 / $1,128.72
| Facility | | $752.48 | $978.22 | $1,128.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,605.73 / $2,605.73 / $3,088.84
| Facility | | $2,605.73 | $2,605.73 | $3,088.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,932.00 / $8,582.00 / $12,569.00
| Facility | | $3,932.00 | $8,582.00 | $12,569.00 |