- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $731.58 / $4,846.00 / $16,042.00
| Facility | | $731.58 | $4,846.00 | $16,042.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,153.00 / $5,790.87 / $8,240.00
| Facility | | $1,153.00 | $5,790.87 | $8,240.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $684.20 / $872.01 / $1,006.17
| Facility | | $684.20 | $872.01 | $1,006.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,243.79 / $2,243.79 / $2,243.79
| Facility | | $2,243.79 | $2,243.79 | $2,243.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,932.00 / $8,025.00 / $11,038.00
| Facility | | $3,932.00 | $8,025.00 | $11,038.00 |