- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $708.97 / $3,437.46 / $7,212.00
| Facility | | $708.97 | $3,437.46 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,852.40 / $10,338.00 / $26,304.00
| Facility | | $1,852.40 | $10,338.00 | $26,304.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $705.03 / $898.57 / $1,036.82
| Facility | | $705.03 | $898.57 | $1,036.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,937.93 / $5,937.93 / $7,038.83
| Facility | | $5,937.93 | $5,937.93 | $7,038.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,472.00 / $10,113.00 / $15,750.00
| Facility | | $4,472.00 | $10,113.00 | $15,750.00 |