- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $802.97 / $5,621.00 / $9,870.00
| Facility | | $802.97 | $5,621.00 | $9,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,077.74 / $8,155.06 / $14,268.09
| Facility | | $3,077.74 | $8,155.06 | $14,268.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $2,106.17 / $2,706.47
| Facility | | $505.00 | $2,106.17 | $2,706.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $633.14 / $838.33 / $1,377.98
| Facility | | $633.14 | $838.33 | $1,377.98 |
- 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 |