- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $740.57 / $3,680.18 / $14,063.00
| Facility | | $740.57 | $3,680.18 | $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
- $772.50 / $1,090.58 / $1,635.89
| Facility | | $772.50 | $1,090.58 | $1,635.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,868.80 / $1,868.80 / $1,868.80
| Facility | | $1,868.80 | $1,868.80 | $1,868.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,364.00 / $6,094.00 / $10,413.00
| Facility | | $3,364.00 | $6,094.00 | $10,413.00 |