- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $723.20 / $3,622.38 / $14,063.00
| Facility | | $723.20 | $3,622.38 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,683.00 / $11,305.00 / $30,091.00
| Facility | | $1,683.00 | $11,305.00 | $30,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $663.64 / $862.73 / $4,392.25
| Facility | | $663.64 | $862.73 | $4,392.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $1,247.19 / $3,833.32
| Facility | | $761.00 | $1,247.19 | $3,833.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,300.00 / $11,200.00 / $17,416.00
| Facility | | $3,300.00 | $11,200.00 | $17,416.00 |