- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.68 / $5,916.63 / $9,727.00
| Facility | | $953.68 | $5,916.63 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,189.37 / $9,828.62 / $18,314.23
| Facility | | $3,189.37 | $9,828.62 | $18,314.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $780.00 / $2,581.96
| Facility | | $505.00 | $780.00 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $929.83 / $1,192.09 / $1,930.47
| Facility | | $929.83 | $1,192.09 | $1,930.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,327.00 / $12,269.00 / $19,591.00
| Facility | | $2,327.00 | $12,269.00 | $19,591.00 |