- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $886.27 / $5,103.76 / $9,727.00
| Facility | | $886.27 | $5,103.76 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,133.92 / $5,551.01 / $9,227.19
| Facility | | $2,133.92 | $5,551.01 | $9,227.19 |
- 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
- $699.68 / $918.98 / $1,519.05
| Facility | | $699.68 | $918.98 | $1,519.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.00 / $10,257.00 / $16,249.00
| Facility | | $791.00 | $10,257.00 | $16,249.00 |