- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $412.87 / $3,500.00 / $16,042.00
| Facility | | $412.87 | $3,500.00 | $16,042.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,390.00 / $10,182.00 / $16,615.00
| Facility | | $3,390.00 | $10,182.00 | $16,615.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $408.08 / $530.50 / $612.12
| Facility | | $408.08 | $530.50 | $612.12 |
- 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
- $2,719.19 / $9,549.00 / $15,660.00
| Facility | | $2,719.19 | $9,549.00 | $15,660.00 |