- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $705.21 / $1,941.00 / $7,212.00
| Facility | | $705.21 | $1,941.00 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,796.00 / $6,340.00 / $15,727.00
| Facility | | $2,796.00 | $6,340.00 | $15,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $654.30 / $833.92 / $962.22
| Facility | | $654.30 | $833.92 | $962.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,909.74 / $3,909.74 / $3,909.74
| Facility | | $3,909.74 | $3,909.74 | $3,909.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,699.00 / $10,000.00 / $15,750.00
| Facility | | $4,699.00 | $10,000.00 | $15,750.00 |