- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $550.51 / $2,318.00 / $16,042.00
| Facility | | $550.51 | $2,318.00 | $16,042.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,904.00 / $7,581.00 / $14,620.00
| Facility | | $2,904.00 | $7,581.00 | $14,620.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $547.33 / $751.24 / $1,126.85
| Facility | | $547.33 | $751.24 | $1,126.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,868.80 / $1,868.80 / $2,215.28
| Facility | | $1,868.80 | $1,868.80 | $2,215.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,472.00 / $10,113.00 / $15,750.00
| Facility | | $4,472.00 | $10,113.00 | $15,750.00 |