- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $753.40 / $4,846.00 / $17,225.00
| Facility | | $753.40 | $4,846.00 | $17,225.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,852.40 / $10,338.00 / $26,304.00
| Facility | | $1,852.40 | $10,338.00 | $26,304.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $742.03 / $1,018.47 / $1,527.71
| Facility | | $742.03 | $1,018.47 | $1,527.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,909.74 / $3,909.74 / $4,634.62
| Facility | | $3,909.74 | $3,909.74 | $4,634.62 |
- 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 |