- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $924.19 / $2,318.00 / $7,212.00
| Facility | | $924.19 | $2,318.00 | $7,212.00 |
- 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
- $890.93 / $1,158.21 / $1,336.40
| Facility | | $890.93 | $1,158.21 | $1,336.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,995.27 / $4,995.27 / $5,921.40
| Facility | | $4,995.27 | $4,995.27 | $5,921.40 |
- 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 |