- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $793.15 / $2,528.00 / $8,229.00
| Facility | | $793.15 | $2,528.00 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,516.00 / $10,990.10 / $30,856.09
| Facility | | $4,516.00 | $10,990.10 | $30,856.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $845.03 / $1,231.08 / $1,420.16
| Facility | | $845.03 | $1,231.08 | $1,420.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,081.74 / $1,081.74 / $1,081.74
| Facility | | $1,081.74 | $1,081.74 | $1,081.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $973.00 / $4,639.00 / $12,296.00
| Facility | | $973.00 | $4,639.00 | $12,296.00 |