- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $595.61 / $4,846.00 / $14,063.00
| Facility | | $595.61 | $4,846.00 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,807.00 / $7,833.00 / $14,645.00
| Facility | | $2,807.00 | $7,833.00 | $14,645.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $583.95 / $759.14 / $875.93
| Facility | | $583.95 | $759.14 | $875.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,116.34 / $2,116.34 / $2,508.71
| Facility | | $2,116.34 | $2,116.34 | $2,508.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,932.00 / $8,582.00 / $12,569.00
| Facility | | $3,932.00 | $8,582.00 | $12,569.00 |