- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.12 / $4,846.00 / $17,639.66
| Facility | | $842.12 | $4,846.00 | $17,639.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,322.00 / $10,182.00 / $16,615.00
| Facility | | $4,322.00 | $10,182.00 | $16,615.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.53 / $1,141.32 / $1,711.98
| Facility | | $831.53 | $1,141.32 | $1,711.98 |
- 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
- $3,932.00 / $8,348.00 / $12,569.00
| Facility | | $3,932.00 | $8,348.00 | $12,569.00 |