- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.16 / $4,846.00 / $11,093.00
| Facility | | $676.16 | $4,846.00 | $11,093.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,153.00 / $7,230.00 / $18,942.00
| Facility | | $1,153.00 | $7,230.00 | $18,942.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $657.71 / $855.02 / $986.57
| Facility | | $657.71 | $855.02 | $986.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,610.75 / $1,610.75 / $1,909.39
| Facility | | $1,610.75 | $1,610.75 | $1,909.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,364.00 / $6,032.00 / $10,413.00
| Facility | | $3,364.00 | $6,032.00 | $10,413.00 |