- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $740.89 / $1,080.69 / $8,229.00
| Facility | | $740.89 | $1,080.69 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,320.00 / $4,334.00 / $11,433.00
| Facility | | $2,320.00 | $4,334.00 | $11,433.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $806.73 / $1,154.30 / $1,331.58
| Facility | | $806.73 | $1,154.30 | $1,331.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,016.63 / $1,016.63 / $1,064.14
| Facility | | $1,016.63 | $1,016.63 | $1,064.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.00 / $4,539.00 / $10,113.00
| Facility | | $842.00 | $4,539.00 | $10,113.00 |