- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $694.64 / $4,846.00 / $20,991.94
| Facility | | $694.64 | $4,846.00 | $20,991.94 |
- 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
- $679.59 / $883.47 / $1,019.39
| Facility | | $679.59 | $883.47 | $1,019.39 |
- 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 / $5,174.00 / $9,243.00
| Facility | | $2,719.19 | $5,174.00 | $9,243.00 |