- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $996.19 / $1,090.86 / $4,846.00
| Facility | | $996.19 | $1,090.86 | $4,846.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,389.00 / $10,288.00 / $26,304.00
| Facility | | $1,389.00 | $10,288.00 | $26,304.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $909.06 / $1,181.78 / $1,363.59
| Facility | | $909.06 | $1,181.78 | $1,363.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $1,131.51
| Facility | | $761.00 | $761.00 | $1,131.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,500.00 / $5,995.00 / $9,243.00
| Facility | | $1,500.00 | $5,995.00 | $9,243.00 |