- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $972.52 / $1,615.00 / $12,247.00
| Facility | | $972.52 | $1,615.00 | $12,247.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,182.48 / $1,182.48 / $7,708.97
| Facility | | $1,182.48 | $1,182.48 | $7,708.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $972.52 / $1,409.14 / $2,060.56
| Facility | | $972.52 | $1,409.14 | $2,060.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,015.00 / $15,545.00 / $22,780.00
| Facility | | $4,015.00 | $15,545.00 | $22,780.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,454.00 / $25,476.75 / $26,542.00
| Facility | | $5,454.00 | $25,476.75 | $26,542.00 |