- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $798.03 / $1,243.00 / $13,304.00
| Facility | | $798.03 | $1,243.00 | $13,304.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,104.00 / $5,199.00 / $12,101.00
| Facility | | $3,104.00 | $5,199.00 | $12,101.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $857.08 / $1,235.74 / $1,425.51
| Facility | | $857.08 | $1,235.74 | $1,425.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,083.05 / $1,083.05 / $1,204.10
| Facility | | $1,083.05 | $1,083.05 | $1,204.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $973.00 / $4,639.00 / $12,296.00
| Facility | | $973.00 | $4,639.00 | $12,296.00 |