- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $751.79 / $2,318.00 / $11,093.00
| Facility | | $751.79 | $2,318.00 | $11,093.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,318.00 / $6,474.00 / $13,758.00
| Facility | | $2,318.00 | $6,474.00 | $13,758.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.25 / $1,029.76 / $1,544.64
| Facility | | $750.25 | $1,029.76 | $1,544.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,116.34 / $2,116.34 / $2,508.71
| Facility | | $2,116.34 | $2,116.34 | $2,508.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,846.00 / $8,348.00 / $12,569.00
| Facility | | $3,846.00 | $8,348.00 | $12,569.00 |