- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $762.77 / $2,318.00 / $16,042.00
| Facility | | $762.77 | $2,318.00 | $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
- $759.02 / $1,041.80 / $1,562.70
| Facility | | $759.02 | $1,041.80 | $1,562.70 |
- 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 |