- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $772.60 / $4,846.00 / $11,093.00
| Facility | | $772.60 | $4,846.00 | $11,093.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,473.00 / $7,890.00 / $32,252.00
| Facility | | $3,473.00 | $7,890.00 | $32,252.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $759.03 / $1,041.81 / $1,562.72
| Facility | | $759.03 | $1,041.81 | $1,562.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,705.12 / $4,705.12 / $5,577.46
| Facility | | $4,705.12 | $4,705.12 | $5,577.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,472.00 / $10,113.00 / $15,750.00
| Facility | | $4,472.00 | $10,113.00 | $15,750.00 |