- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $754.56 / $2,318.00 / $14,063.00
| Facility | | $754.56 | $2,318.00 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,536.00 / $7,833.00 / $14,645.00
| Facility | | $3,536.00 | $7,833.00 | $14,645.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $755.25 / $1,036.61 / $1,554.93
| Facility | | $755.25 | $1,036.61 | $1,554.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,116.34 / $2,116.34 / $2,508.71
| Facility | | $2,116.34 | $2,116.34 | $2,508.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,431.00 / $12,330.00 / $17,416.00
| Facility | | $5,431.00 | $12,330.00 | $17,416.00 |