- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $932.61 / $1,034.40 / $4,846.00
| Facility | | $932.61 | $1,034.40 | $4,846.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,600.00 / $11,226.46 / $15,429.17
| Facility | | $4,600.00 | $11,226.46 | $15,429.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $862.00 / $1,120.59 / $1,293.00
| Facility | | $862.00 | $1,120.59 | $1,293.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $1,105.96
| Facility | | $761.00 | $761.00 | $1,105.96 |
- 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 |