- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.77 / $4,908.03 / $10,492.00
| Facility | | $125.77 | $4,908.03 | $10,492.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,410.00 / $6,763.00 / $10,432.00
| Facility | | $5,410.00 | $6,763.00 | $10,432.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $550.00 / $1,309.52 / $1,309.52
| Facility | | $550.00 | $1,309.52 | $1,309.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,340.80 / $1,643.00 / $1,677.00
| Facility | | $1,340.80 | $1,643.00 | $1,677.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,157.00 / $4,210.00 / $7,760.00
| Facility | | $1,157.00 | $4,210.00 | $7,760.00 |