- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $972.07 / $4,450.00 / $8,031.00
| Facility | | $972.07 | $4,450.00 | $8,031.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,402.00 / $4,203.74 / $7,714.00
| Facility | | $2,402.00 | $4,203.74 | $7,714.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $767.00 / $1,409.72 / $1,623.02
| Facility | | $767.00 | $1,409.72 | $1,623.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.19 / $886.65 / $1,552.85
| Facility | | $549.19 | $886.65 | $1,552.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $911.00 / $5,307.00 / $8,879.00
| Facility | | $911.00 | $5,307.00 | $8,879.00 |