- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $502.47 / $3,500.00 / $16,042.00
| Facility | | $502.47 | $3,500.00 | $16,042.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,536.00 / $10,284.00 / $16,778.00
| Facility | | $3,536.00 | $10,284.00 | $16,778.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $477.28 / $608.29 / $701.88
| Facility | | $477.28 | $608.29 | $701.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,258.41 / $2,258.41 / $2,258.41
| Facility | | $2,258.41 | $2,258.41 | $2,258.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,932.00 / $8,348.00 / $11,284.00
| Facility | | $3,932.00 | $8,348.00 | $11,284.00 |