- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $733.51 / $4,077.69 / $7,212.00
| Facility | | $733.51 | $4,077.69 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,943.00 / $5,126.00 / $8,240.00
| Facility | | $1,943.00 | $5,126.00 | $8,240.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $733.53 / $1,006.81 / $1,510.22
| Facility | | $733.53 | $1,006.81 | $1,510.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,239.56 / $1,239.56 / $1,469.38
| Facility | | $1,239.56 | $1,239.56 | $1,469.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,636.54 / $5,174.00 / $9,243.00
| Facility | | $1,636.54 | $5,174.00 | $9,243.00 |