- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $628.28 / $4,283.54 / $11,093.00
| Facility | | $628.28 | $4,283.54 | $11,093.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,411.35 / $7,572.00 / $18,942.00
| Facility | | $1,411.35 | $7,572.00 | $18,942.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $644.61 / $849.37 / $1,274.06
| Facility | | $644.61 | $849.37 | $1,274.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,610.75 / $1,610.75 / $1,909.39
| Facility | | $1,610.75 | $1,610.75 | $1,909.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,364.00 / $5,620.00 / $10,413.00
| Facility | | $3,364.00 | $5,620.00 | $10,413.00 |