- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $745.84 / $2,318.00 / $11,093.00
| Facility | | $745.84 | $2,318.00 | $11,093.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,140.00 / $5,948.00 / $9,462.00
| Facility | | $2,140.00 | $5,948.00 | $9,462.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.42 / $1,017.63 / $1,526.45
| Facility | | $741.42 | $1,017.63 | $1,526.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,123.45 / $1,123.45 / $1,331.74
| Facility | | $1,123.45 | $1,123.45 | $1,331.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.00 / $2,291.00 / $4,426.00
| Facility | | $933.00 | $2,291.00 | $4,426.00 |