- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.13 / $4,862.00 / $9,727.00
| Facility | | $311.13 | $4,862.00 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,915.73 / $4,999.56 / $8,705.65
| Facility | | $1,915.73 | $4,999.56 | $8,705.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.26 / $375.00 / $2,581.96
| Facility | | $307.26 | $375.00 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.02 / $420.03 / $803.00
| Facility | | $307.02 | $420.03 | $803.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,550.00 / $10,878.00 / $16,772.00
| Facility | | $1,550.00 | $10,878.00 | $16,772.00 |