- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $754.78 / $2,318.00 / $14,063.00
| Facility | | $754.78 | $2,318.00 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,807.00 / $8,512.00 / $16,307.00
| Facility | | $2,807.00 | $8,512.00 | $16,307.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $749.47 / $1,028.68 / $1,543.02
| Facility | | $749.47 | $1,028.68 | $1,543.02 |
- 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 |