- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.60 / $2,485.09 / $14,063.00
| Facility | | $860.60 | $2,485.09 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,807.00 / $6,653.00 / $11,752.00
| Facility | | $2,807.00 | $6,653.00 | $11,752.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $792.48 / $1,154.31 / $1,262.47
| Facility | | $792.48 | $1,154.31 | $1,262.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,314.83 / $1,314.83 / $1,314.83
| Facility | | $1,314.83 | $1,314.83 | $1,314.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,400.00 / $3,870.00 / $5,490.00
| Facility | | $2,400.00 | $3,870.00 | $5,490.00 |