- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $974.17 / $2,007.88 / $16,467.00
| Facility | | $974.17 | $2,007.88 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,172.34 / $5,676.69 / $9,815.46
| Facility | | $2,172.34 | $5,676.69 | $9,815.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,711.96 / $3,711.96 / $4,769.93
| Facility | | $3,711.96 | $3,711.96 | $4,769.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.59 / $1,022.88 / $1,682.23
| Facility | | $796.59 | $1,022.88 | $1,682.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.00 / $10,257.00 / $16,249.00
| Facility | | $791.00 | $10,257.00 | $16,249.00 |