- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $454.93 / $4,846.00 / $11,557.18
| Facility | | $454.93 | $4,846.00 | $11,557.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,796.00 / $6,340.00 / $30,900.00
| Facility | | $2,796.00 | $6,340.00 | $30,900.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $455.95 / $625.80 / $938.72
| Facility | | $455.95 | $625.80 | $938.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,267.64 / $6,267.64 / $7,429.67
| Facility | | $6,267.64 | $6,267.64 | $7,429.67 |
- 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 |