- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $848.54 / $2,318.00 / $14,063.00
| Facility | | $848.54 | $2,318.00 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,807.00 / $6,653.00 / $11,752.00
| Facility | | $2,807.00 | $6,653.00 | $11,752.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $807.37 / $1,080.86 / $1,634.93
| Facility | | $807.37 | $1,080.86 | $1,634.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $560.00 / $798.00 / $1,375.01
| Facility | | $560.00 | $798.00 | $1,375.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,399.00 / $5,995.00 / $10,413.00
| Facility | | $1,399.00 | $5,995.00 | $10,413.00 |