- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.10 / $1,034.02 / $4,846.00
| Facility | | $941.10 | $1,034.02 | $4,846.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,600.00 / $10,316.68 / $15,154.00
| Facility | | $4,600.00 | $10,316.68 | $15,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $861.68 / $1,120.18 / $1,292.52
| Facility | | $861.68 | $1,120.18 | $1,292.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $1,070.95
| Facility | | $761.00 | $761.00 | $1,070.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.00 / $5,076.00 / $10,396.00
| Facility | | $612.00 | $5,076.00 | $10,396.00 |