- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $865.14 / $4,440.80 / $9,727.00
| Facility | | $865.14 | $4,440.80 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,672.40 / $10,104.21 / $18,314.23
| Facility | | $3,672.40 | $10,104.21 | $18,314.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $780.00 / $7,240.97
| Facility | | $505.00 | $780.00 | $7,240.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $798.00 / $1,073.85 / $1,668.52
| Facility | | $798.00 | $1,073.85 | $1,668.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $16,223.00 / $23,485.00
| Facility | | $2,912.00 | $16,223.00 | $23,485.00 |