- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $972.01 / $1,688.00 / $7,293.00
| Facility | | $972.01 | $1,688.00 | $7,293.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,027.36 / $3,027.36 / $3,632.83
| Facility | | $3,027.36 | $3,027.36 | $3,632.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $952.90 / $1,037.89 / $3,024.00
| Facility | | $952.90 | $1,037.89 | $3,024.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,025.06 / $4,025.06 / $4,025.06
| Facility | | $4,025.06 | $4,025.06 | $4,025.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,565.00 / $2,828.00 / $6,957.00
| Facility | | $1,565.00 | $2,828.00 | $6,957.00 |