- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $578.26 / $4,846.00 / $11,093.00
| Facility | | $578.26 | $4,846.00 | $11,093.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,318.00 / $6,474.00 / $13,758.00
| Facility | | $2,318.00 | $6,474.00 | $13,758.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $553.11 / $719.04 / $829.67
| Facility | | $553.11 | $719.04 | $829.67 |
- 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 / $7,672.00 / $11,284.00
| Facility | | $2,719.19 | $7,672.00 | $11,284.00 |