- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.24 / $5,621.00 / $9,870.00
| Facility | | $860.24 | $5,621.00 | $9,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,792.31 / $9,602.04 / $16,952.09
| Facility | | $3,792.31 | $9,602.04 | $16,952.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $3,711.96 / $4,769.93
| Facility | | $505.00 | $3,711.96 | $4,769.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $705.72 / $918.22 / $1,605.97
| Facility | | $705.72 | $918.22 | $1,605.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $16,959.00 / $23,485.00
| Facility | | $2,912.00 | $16,959.00 | $23,485.00 |