- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $847.10 / $3,683.00 / $9,257.00
| Facility | | $847.10 | $3,683.00 | $9,257.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,726.17 / $7,392.01 / $11,593.95
| Facility | | $4,726.17 | $7,392.01 | $11,593.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,545.78 / $2,545.78 / $2,545.78
| Facility | | $2,545.78 | $2,545.78 | $2,545.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $521.41 / $767.27 / $5,465.00
| Facility | | $521.41 | $767.27 | $5,465.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.00 / $2,900.00 / $5,543.93
| Facility | | $884.00 | $2,900.00 | $5,543.93 |