- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $717.16 / $2,518.00 / $3,884.00
| Facility | | $717.16 | $2,518.00 | $3,884.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,035.25 / $9,184.95 / $15,041.46
| Facility | | $5,035.25 | $9,184.95 | $15,041.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $456.79 / $2,807.66
| Facility | | $40.00 | $456.79 | $2,807.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $488.00 / $596.29 / $4,042.13
| Facility | | $488.00 | $596.29 | $4,042.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $968.00 / $4,717.00 / $10,959.00
| Facility | | $968.00 | $4,717.00 | $10,959.00 |