- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $793.93 / $2,318.00 / $11,093.00
| Facility | | $793.93 | $2,318.00 | $11,093.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.00 / $5,948.00 / $9,462.00
| Facility | | $2,754.00 | $5,948.00 | $9,462.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $853.05 / $1,163.25 / $1,744.88
| Facility | | $853.05 | $1,163.25 | $1,744.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,239.56 / $1,239.56 / $1,239.56
| Facility | | $1,239.56 | $1,239.56 | $1,239.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,253.00 / $6,434.00 / $10,413.00
| Facility | | $3,253.00 | $6,434.00 | $10,413.00 |