- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $848.57 / $1,459.71 / $10,152.00
| Facility | | $848.57 | $1,459.71 | $10,152.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,559.00 / $10,990.10 / $30,856.09
| Facility | | $6,559.00 | $10,990.10 | $30,856.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $904.79 / $1,304.20 / $1,504.48
| Facility | | $904.79 | $1,304.20 | $1,504.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,144.79 / $1,144.79 / $1,263.01
| Facility | | $1,144.79 | $1,144.79 | $1,263.01 |
- 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 |