- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $820.24 / $5,454.74 / $17,247.00
| Facility | | $820.24 | $5,454.74 | $17,247.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,806.94 / $5,970.21 / $9,892.90
| Facility | | $2,806.94 | $5,970.21 | $9,892.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $806.78 / $1,130.00 / $2,279.96
| Facility | | $806.78 | $1,130.00 | $2,279.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.84 / $907.40 / $1,568.55
| Facility | | $756.84 | $907.40 | $1,568.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $10,147.00 / $16,816.00
| Facility | | $1,981.00 | $10,147.00 | $16,816.00 |