- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $947.38 / $7,686.00 / $13,370.31
| Facility | | $947.38 | $7,686.00 | $13,370.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.00 / $2,844.33 / $5,654.79
| Facility | | $515.00 | $2,844.33 | $5,654.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $617.48 / $826.11 / $1,177.23
| Facility | | $617.48 | $826.11 | $1,177.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,503.00 / $5,293.00 / $15,712.00
| Facility | | $1,503.00 | $5,293.00 | $15,712.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,508.92 / $16,547.20 / $26,542.00
| Facility | | $3,508.92 | $16,547.20 | $26,542.00 |