- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $740.90 / $2,318.00 / $14,063.00
| Facility | | $740.90 | $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
- $772.85 / $1,091.08 / $1,636.64
| Facility | | $772.85 | $1,091.08 | $1,636.64 |
- 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 |