- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $460.92 / $4,862.00 / $10,085.81
| Facility | | $460.92 | $4,862.00 | $10,085.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $671.77 / $2,949.69 / $6,567.07
| Facility | | $671.77 | $2,949.69 | $6,567.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,021.41 / $2,021.41 / $2,597.55
| Facility | | $2,021.41 | $2,021.41 | $2,597.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.24 / $476.80 / $749.50
| Facility | | $350.24 | $476.80 | $749.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $13,680.00 / $20,474.00
| Facility | | $2,155.00 | $13,680.00 | $20,474.00 |