- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $494.01 / $5,192.00 / $11,723.52
| Facility | | $494.01 | $5,192.00 | $11,723.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,317.76 / $8,625.95 / $14,519.88
| Facility | | $3,317.76 | $8,625.95 | $14,519.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $3,208.42 / $4,122.88
| Facility | | $505.00 | $3,208.42 | $4,122.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $411.98 / $582.05 / $947.68
| Facility | | $411.98 | $582.05 | $947.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $16,959.00 / $23,485.00
| Facility | | $2,912.00 | $16,959.00 | $23,485.00 |