- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $609.01 / $5,498.18 / $13,335.00
| Facility | | $609.01 | $5,498.18 | $13,335.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,911.85 / $6,852.09 / $12,097.16
| Facility | | $2,911.85 | $6,852.09 | $12,097.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $610.79 / $2,345.00 / $2,581.96
| Facility | | $610.79 | $2,345.00 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $574.07 / $692.11 / $1,147.68
| Facility | | $574.07 | $692.11 | $1,147.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $12,456.00 / $19,591.00
| Facility | | $2,155.00 | $12,456.00 | $19,591.00 |