- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $885.91 / $1,838.16 / $2,465.73
| Facility | | $885.91 | $1,838.16 | $2,465.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $599.55 / $1,898.11 / $3,560.72
| Facility | | $599.55 | $1,898.11 | $3,560.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,205.00 / $1,205.00 / $1,205.00
| Facility | | $1,205.00 | $1,205.00 | $1,205.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,562.44 / $1,879.12 / $3,291.57
| Facility | | $1,562.44 | $1,879.12 | $3,291.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $318.00 / $633.00 / $5,713.00
| Facility | | $318.00 | $633.00 | $5,713.00 |