- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $869.87 / $1,312.40 / $11,093.00
| Facility | | $869.87 | $1,312.40 | $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
- $792.10 / $1,087.20 / $1,630.80
| Facility | | $792.10 | $1,087.20 | $1,630.80 |
- 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
- $3,364.00 / $6,032.00 / $10,413.00
| Facility | | $3,364.00 | $6,032.00 | $10,413.00 |