- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $654.64 / $2,970.10 / $11,909.00
| Facility | | $654.64 | $2,970.10 | $11,909.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,929.85 / $7,184.75 / $12,668.74
| Facility | | $2,929.85 | $7,184.75 | $12,668.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.00 / $2,144.17 / $2,755.30
| Facility | | $715.00 | $2,144.17 | $2,755.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $517.17 / $714.42 / $1,115.64
| Facility | | $517.17 | $714.42 | $1,115.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,597.44 / $12,269.00 / $19,591.00
| Facility | | $2,597.44 | $12,269.00 | $19,591.00 |